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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> u <br /> A. EMERGENCY LEVEL I II III PHS-EH LOG # C, <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: ; Telephone: <br /> Reporting Agency Name: ;i. , _ 00u fid. I <br /> '!',-„ -t— <br /> Agency Contact: �� n _ !�;-r; Telephone: <br /> Address: — E �, <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: ih -tn I io <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: I r'1 vr 0 <br /> Date Notified: <br /> Time: <br /> D. RESPONSIBLE PERSONBUSINESS <br /> Name of Business —L <br /> r <br /> Contact Person: „ ,_ ,j, Telephone: ( - <br /> LL <br /> Physical Address: �y ' 17 — <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: k ?N” ; >, <br /> Chemicals: <br /> F. AC'T'ION TAKEN <br /> P 3- <br /> :H 22 03 (Rev. 7/89) <br />