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_ SAN JOAQUIN COUNTY <br /> NOTIFIC?�TION OF HAZARDOUS WASTE DI96AARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: 0 II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: _ � r j1 i P/ '� Telephone: ( '�5 ) �� " �t2 7 <br /> Reporting Agency Name: 4 e G I �n / �) c <br /> Agency Contact: Telephone: <br /> T, Address: 44te <br /> ,per C. LOCATION AND DATE OF DISCHARGE <br /> Location: y S. 1 ` ? / S k�p <br /> (Best Physical Descripti (City or County) <br /> Date of Discharge: i/��ilovn <br /> Date Notified: `d 5�' ' a (= Time: 1,4 1,VV4 <br /> o D. RESPONSIBLE PERSONBUSINESS <br /> Name of Business ("�?Orc^ l) S. ,Q- ),qc <br /> Contact Person: ti, s� Telephone: �/( Vis ) <br /> �j Physical Address: <br /> E. DESCRIPTION <br /> JType Release: <br /> Volume: r �fiio✓� <br /> Chemicals: <br /> F. ACTION TAKEN / <br /> ILI <br /> 77 <br /> /_ <br /> /UmJ 'h`CS htrn is �i �c�Q C� S <br /> L/Ylr .ry <br /> EH 22 03 (Rev. 7/89) <br />