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i % <br /> SAN JOAQUIN COUNTY I <br /> NOTIFICAI ION OF HAZARDOUS WASTE 13TSCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVELS I ) II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: )&M Telephone: <br /> Reporting Agency Name: <br /> Agency Contact: Telephone: Laj <br /> Address: 446 L Ca," St 2� <br /> C. LOCATION AND DATE OF DIS GE <br /> Location: / G��ari1 <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: ta.+ k4zw �-' <br /> Date Notified: —U q 1 Time: ' bfl py� <br /> D. RESPONSIBLE PERSONBUSINESS <br /> Name of Business <br /> Contact Person: & �j WYn - Telephone: <br /> Physical Address: '2'Ll all �^ �; �cn <br /> E. DESCRIPTIONp rr <br /> Type Release: PQ Vl�^ C�"nP^nhrtio �,[M- a mot. U."nc4W&� Aaae�ua <br /> Volume: J, <br /> Chemicals: <br /> F. ACTION TAKEN <br /> �cnEcLik k4u (IM, <br /> rlGotj rJywvuc td, 4,6- 1h PAP <br /> b &I-;z U—Lu <br /> :H 22 03 (Rev. 7/89) <br /> cap <br />