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i •i p j�f/ iIF <br /> � SAN JOAQUIN COUN'T'Y (/ <br /> NOTIFICA'T`ION;OF HAZARDOUS WASTE y1tSCHARIGE <br />` HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II III< `, PHS-EH LOG # CO-9 ~ <br /> Circle One) <br /> B. SOURCE OF INFORMATION r <br /> �. <br />� <br /> Original Source: ��� . . � Telephone: (�) � <br /> i <br /> Reporting Agen Name: G <br /> Agency Cohtacti Telep one: ( ) <br /> Address: y <br />€ C. LOCATION AND DATE OF,131SCHARGE <br /> Location: <br /> Ci or Count <br /> (Best Physibal Description), . (City y) � <br /> Date of Discharges <br /> l Date Notified: . u Time: '9:o� <br /> ,. <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business <br /> Contact Person: Telephone: 73 <br /> Physical Address:' w���� e� �• <br /> E. DESCRIPTIO y. �. ,k h �r s= ., IT: .. . . <br /> Type Release. i <br /> a; <br /> Volume: <br /> U4k <br /> i,j. •II Yf i <br /> { <br /> Chemicals: - <br /> M1 F. ACTION TAKEN <br /> alike- <br /> fit Ar' <br /> 1 <br /> is <br /> EH 22 03 (Rev. 7/89)` <br /> SYS <br /> _ bis <br />