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SAN JOAQUIN COUNTY • <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION " � � <br /> Original Source: �J G�J(Z/i�u/liriL�� Telephone: (� �/o ' rj�J// <br /> Reporting Agency Name: <br /> Agency Contact: ( Telephone: c1(�) F6 B 3 ya U <br /> Address: ?S120 <br /> C. LOCATION AND DATE OF DISCHARGE �� <br /> Location: / <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: <br /> Date Notified: / o`Z-7 — q D Time: 91< 3 O Cyryy <br /> D. RESPONSIBLE PERSON/BUSnINESS <br /> Name of Business 1 ,0 �. . �l Cri ,' cu Hzo 0.�l sliiyiyK� <br /> Contact Person: Telephone: (2aD !fa 42 9// <br /> Physical Address: P 61 43-6xU 1 D 5 q 4 C-K� <br /> E. DESCRIPTION <br /> Type Release: <br /> loin u � <br /> Volume: <br /> Chemicals: <br /> F. ACTION TAKEN "p <br /> , <br /> Dy2r✓v q= <br /> ` C <br /> D,p JJDa- DDD <br /> r <br /> l <br /> EH 22 013 (Rev. 02/90) <br />