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tl <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGECOD,, , <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: CJ II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: 151 Telephone: <br /> Reporting Agency Name: <br /> Agency Contact: Telephone: <br /> Address: D , o >a 20 0 2 ��O C�do►1, C�9- 1s"z°/ <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: /91/S /V? ele / <br /> fpm�rr�T; cam.- fz5�o-� <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: /d`3"� <br /> 52 <br /> Date Notified: /d�— 9 Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business G h ^/7", .� 5 <br /> �/ <br /> Contact Person: A/XII/ Telephone: 47 /46�-2-V <br /> Physical Address: <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: �aDA <br /> Chemicals: <br /> F. ACTION TAKEN <br /> G✓a r <br /> j, l es, <br /> EH 22 03 (Rev. 7/89) <br />