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SAN JOAQUIN COUNTY <br /> NOTIFICAT vN OF HAZARDOUS WASTE DI. GE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: Q II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATIO <br /> Original Source: l-(7`Gc -,S GL Telephone: 0.�D y& <br /> Reporting Agency Name: 3 C�ei G D <br /> Agency Contact: Tele hone: f�f ( )�/�E- 3 c/37 <br /> Address:, ,i�r1Y�C,d S4,-13 7�`/� �i� <br /> C. LOCATION AN DATE F DISC GE <br /> Location: 95 <br /> (Best Physical Description) (City or ounty) <br /> Date of Discharge: <br /> Date Notified: 3 Time: d aJ <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business F7 * H ������"""""' /�`'LJ <br /> Contact Person: Tele hone: o6 j/ —3 7 3 <br /> sa 0s <br /> Physical Address: / <br /> E. DESCRIPTION C�t7C�- �'i71t11� <br /> Type Release: i <br /> ce, 83 <br /> Volume: <br /> Chemicals: <br /> F. ACTION TAKEN <br /> 114 <br /> D BDl rte' Cts ` �' <br /> EH 22 013 (Rev. 02/90) <br />