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SAN JOAQUIN COUNTY <br /> NOTIFICA i-ION OF HAZARDOUS WASTE 1Llo HARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL. I II III PHS-EH LOG # � C) �� y <br /> • <br /> (Circle One) <br /> B. SOURCE OF INFORMATION ��- ���_ Z�g'- <br /> Original Source: Telephone: ( ) <br /> Reporting Agency Name: <br /> .�- Telephone: <br /> Agency Contact: c�2iC_ ,!2 ✓ENS p L-- <br /> Address: �f�r" N - ;� vi nt j cd <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 32)2 r,/ <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: �" '� 1Z IQ Cr <br /> Date Notified: ,I-y/Jrzlc� (z, i q Cr <br /> Time: y -X5�4 <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business l <br /> 7 t <br /> Contact Person: 0-1SNE LA x'/14 Telephone <br /> OD <br /> Physical Address: 5 <br /> E. DESCRIPTION <br /> Type Release: iNAVf�/��z�r� <br /> Volume: UNg-e,�Cxunf <br /> Chemicals: voR UEr ,-:r <br /> F. ACTION TAKEN <br /> G,r i lOrvFt A '7V <br /> �"/�t 5�/LL �[LVK'�i� cy`1Ely d� L'v57a.�rFi°L_ ��LE �yfi.�✓i¢f' <br /> �"sQvar rj'XE 13�sz�IE�S tv/"T-itf- '7"!!� 1.21Si'��`-�'-C� �f/vz2�c {TIAL iNTf-�t <br /> EH 22 013 (Rev. 02/90) <br />