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C <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVELY, PHS-EH LOG # <br /> (Circle One) ----_-.— <br /> B. SOURCE OF INFORMATION <br /> Original Source: Telephone: -7 <br /> Reporting Agency Name: <br /> Agency Contact: 1,(� 1 Telephone: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: �'�yE, ,z G / � . <br /> (Best Physical Descrip n) (City or County) <br /> Date of Discharge: Lv-unw <br /> Date Notified:� �D Time: .d D <br /> D. RESPONSIB PERSON/BUSIJI <br /> NESS <br /> Name of Business <br /> Contact Person: �(, e_ Telephone: �d 3 3 y - <br /> P (�� Q 7 <br /> Physical Address: car Jr a <br /> E. DESCRIPTION . <br /> Type Release: 41 <br /> Volume: <br /> Chemicals: <br /> F. ACTION TAKEN <br /> dc:PSe,e Yla-yt-$L <br /> EH 22 3 (Rev. 7/89)' <br />