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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVE 111144W PHS-EH LOG # �� 13 <br /> rcle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: 7�,� ,_oma,o �,� /,,,s „1 f Telephone: <br /> Reporting Agency Name: -=22/» /42-,/1l, i�icrs <br /> Agency Contact: Telephone: (,iv9 ) <br /> Address• <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: (-,4 <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: <br /> Date Notified: Po Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business <br /> Contact Person: Telephone: <br /> Physical Address: CA <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: <br /> Chemicals: <br /> F. ACTION TAKEN <br /> 46 <br /> /�T -� /Sl t�J �iG» /'rvlPC/ h �•s^ 7 ,� Sli.�-c / sr%l u�r, ` <br /> EH 22 013 (Rev. 02/90) <br />