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SAN JOAQUIN COUNTY <br /> , <br /> NOTIF`,ATION OF HAZARDOUS WAS1DISCHARGE . <br /> j HEALTH & SAFETY CODE 25180.7 <br /> I <br /> f <br /> A. EMERGENCY LEVEL: gi)rcfe <br /> IIII PHS-EH LOG #One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: �lerrr^`, �.rUXttrrY_ Telephone: ( <br /> Reporting Agency Name: ?t )W ir. 14-a 6-k 5�oarV is <br /> Agency Contact: Telephone: Lq <br /> Address: ` lnn4k� <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 6� c� 0. <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: --UriIGfucwO <br /> Date Notified: (r,f Zr3/qD Time: -2' 30 rJm <br /> D. RESPONSIBLE PERSON/BUSINESS n <br /> Name of Business ---O-WaAp 51.errt l✓�,��o� l� >�( ;�✓y�n •din-y, <br /> Contact Person �. ?r✓t / � �� Telephone: ( 2p4) rioa�/ <br /> Physical Address: foo Gc7, cllu.r s el. <br /> E. DESCRIPTION <br /> Type Release:' <br /> u <br /> Volume: <br /> Chemicals: - �( 77U� -IS <br /> F. ACTION TAKEN <br /> U <br /> c . <br /> 61 <br /> EH 22 013 (Rev. 02/90) <br />