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ry SAN JOAQUIN COUNTY <br /> NOTIFIC%ION OF HAZARDOUS WASTCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: II III PHS-EH LOG # D <br /> ( rcle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: S C Telephone: ( fftg(a — cow <br /> Reporting Agency ame: S-- <br /> Agency Contact: Telephone: (- <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: Ski. (j, JJA A dna LJ14 / <br /> (Best Physical Des ription) I (City or County) <br /> Date of Discharge: <br /> Date Notified: f�1 �i _ Time: 3 v <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business Pte? Dkcuo- CLQ =n - - _ <br /> Contact Person: ]?r-bev- ( a UarQ Telephone: (� `4 22 - <br /> Physical Address: 19411 Ve-in L�CXL Ca <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: <br /> Chemicals: S Q DQaC D <br /> F. ACTTON'TAKEN t <br /> EH 22 013 (Rev. 02/90) <br />