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o � <br /> SAN JOAOUIN COUNT <br /> NOTION OF 11AZARDOUS WASTE DISCHARGE <br /> HFALTH & SAFETY CODE 25180.7. <br /> A• EMIEROENCY LEVEL� I II LII PHS-EH LOG # /D <br /> (Circle One) <br /> 13• SOURC9 OF MFORMATION <br /> Original Source: Telephone: <br /> Reporting Agency Name: 4 <br /> Agency Cone; � ��- � Telephone: z <br /> (�)_YF&-3401 <br /> Address: <br /> G <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: . i o <br /> Cal 6104 � <br /> (Best P===aw <br /> (City or County) <br /> Date of Discharge: <br /> Date Notified: yD <br /> I�FSPTime: — 'yi' <br /> !� �J/+'! <br /> D. ONSMLE PER ON/BUSD4ESS . <br /> Name of Business t kct <br /> Contact Person: ►d -�er S Telephone: <br /> Physical Address: Pp 95L3 <br /> E. DESCRIPTION <br /> / <br /> Type Release: �• `�'" orj �+� �►+lri4 <br /> Volume: o�✓ ' <br /> Chemicals: t n <br /> � �e <br /> F. ACTION TAKEN G <br /> s v r t <br /> c <br /> i <br /> hL L S G <br /> cP , <br /> Anef <br /> Wg <br /> r <br /> n <br /> it <br /> r r <br /> EH 22 013 <br /> (Rev 02/90) <br /> D <br />