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✓ SAN JOAQUIN COUNTY e <br /> NOTIFICATION OF HAZARDOUS WASTE DIrLo,HARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG # — l <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: '/ ,,,,fie Telephone: (2o7 Y6,P-3V(,d <br /> Reporting Agency Name: S�„ /Oa 9Uin Pub/« /leu/fesiiuices <br /> Agency Contact: Telephone: o% Y6e f/Gef <br /> Y4i So.� So up%� r oS c.E fob r <br /> Address: 9sazcJ� <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 6/6 S. /l tL4 . - <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: <br /> Date Notified: /-ice-y/ Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business 17?aa/C ca <br /> Contact Person: 1/„ V, Telephone: (2q ) Sa 3 -9�S6 <br /> Physical Address: a 9 o v ..53, ino /m��o 9 e f3 ss <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: <br /> Chemicals: aP�rrn�Y X /• P. To/u� <br /> F. ACTION TAKEN <br /> LL1��2i rss ir.o wi%/ .be �,rcessa.cce �'o <br /> anct eX/end P cow Ar, f^L�Qac f-��au/a�ii�ci <br /> ,7t a <br /> EH 22 013 (Rev. 02/90) <br />