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� t <br /> ` SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE-DISC � GE <br /> HEALTH & SAFETY CODE,25186.7 <br /> A. EMERGENCY LEVEL: II III PHS-EH LOG # r'a5 t <br /> (Circle One) <br /> B. SOURCE OF INFORMATION !� <br /> Original Source: Teleph one; <br /> Reporting Agency Name: j;�5 <br /> Agency Contact: / �� Telephone; <br /> Address: 4 �2Sc� D / <br /> C. LOCATION AND DATE OF DISCHARGE . <br /> I; <br /> ��}} <br /> Location: Cly j J / <br /> (Best Physical Description) (City of County) <br /> Date of Discharge: i' :4. <br /> f. Date Notified: Time: �I <br /> .D. RESPONSIBLE PERSO�N7/B—USINESS <br /> t � <br /> +i Name of Business c �� c <br /> Contact Person: Telephone: <br /> Physical Address: JA C <br /> E. DESCRIPTIONor <br /> Type Release: !� <br /> `i <br /> Volume: <br /> ,!! <br /> Chemicals: <br /> F. ACTION TAKEN ' <br /> • Q -� j �, <br /> EH 22 � � ��•�l� �� <br /> 03 .(� Q I° <br /> a <br />