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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTII & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVELO II III PHS-EH LOG # �� L <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: _2 I <br /> 0�'4W, Telephone: ..��z a 7 T,�4 <br /> Reporting Agency Name: S _, - • v <br /> Agency Contact: � Telephone: <br /> Address: �.� <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: P S 1 E. g Q tl�, <br /> (Best.Physical Description) (City or County) <br /> Date of Discharge: <br /> Date Notified: — -4Time: `CJ <br /> D• RESPONSIBLE PERSON USINESS <br /> Name of Business <br /> Contact Person: Q(112Telephone: <br /> Physical Address: D . .� Q <br /> E. DESCRIPTION r Al <br /> Type Release: <br /> Volume: <br /> Cltem#calaZ`'� <br /> F. ACTION TAKEN <br /> r /A` <br /> YaK- <br /> S S ' ..4er <br /> EH 22 03 ( ev. 7/89)' <br />