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• SAN JOAQUIN COUNTY <br /> NOTIFICA11UN OF HAZARDOUS WASTE D�.,.MHARGE .— <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: © II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATIObL, <br /> nn <br /> Original Source: je'i+Ct EPS GY, Telephoner y/o 3 q,3 c/ <br /> Reporting Agency Name: ', a k& ( <br /> Agency Contact: L A-[4` 4 e,,_- RP_ C-A-1 Telephone: (�)q&�- .3(!3�1 <br /> Address: p i�lJ��P) 9 lC./4 <br /> C. LOCATION �� DATEF DISC GE c a <br /> Location: tf%T� t� — l <br /> (Best Physical Description) (City or ounty) <br /> Date of Discharge: sir a.�['0 <br /> Date Notified: 3 —a S— L Time: � � li'�✓x� <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business ' <br /> Contact Person: Tel hone: <br /> Physical Address: <br /> &e <br /> s sR0S <br /> E. DESCRIPTION <br /> Type Release: y <br /> Volume: <br /> Chemicals: <br /> F. ACTION TAKEN <br /> cG�'�E/✓'( i�YCJ tti� <br /> EH 22 013 (Rev. 02/90) <br />