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• SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: @ II III PHS-EH LOG # <br /> �G ioZ 6� <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: DRtiJ K� zr ©ice CO • _ Telephone: <br /> Reporting Agency N e: �>h/�c �rvkas, OL p <br /> Agency Contact: / �Sr Telephone: 2( OD t-1FS'>'�/� <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: ,30// UY o,- <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: 0-&/L,2 <br /> Date Notified: Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business JA"// 6;/ (20 M'4 ZZ� <br /> Contact Person: T 1ar,,—a - L,2L QUI, -L Telephone: <br /> Physical Address: LEO 11rnwF��S l�c� l� 53190n <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: <br /> Chemicals: <br /> F. ACTION T N <br /> EH 22 013 (Rev. 02/90) <br />