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SAN JOAQUIN COUNTY <br /> NOTIFI�TION OF HAZARDOUS WASYDISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II III PHS- G' `�t? <br /> ( ' cle One) <br /> Lr <br /> B. SOURCE OF INFORMATION <br /> Original Source:„j'`r,�� �,,,,,, Telephone: <br /> Reporting Agency Name: 12 J" Sar✓�� aS <br /> Agency Contact: Telephone: (.�-,) c ls,W- <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: Q !�9. �n&e-n �l / <br /> (Best Physical De cription) (City or County) <br /> Date of Discharge: <br /> Date Notified: Time: a <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business 'Ey- <br /> Contact Person: Telephone: <br /> Physical Address: <br /> E. DESCRIPT[ON <br /> Type Release: &n WaZ ,nrs <br /> Volume: Ulk <br /> Chemicals: L9� <br /> F. ACTION TAKEN <br /> r <br /> LLLCL�t� <br /> l�f/��mi�► � �..f� /)'11��1i/1� T ODIC!�J.,� � l� L1 1f�'�firii�v�%�.n. . <br /> lele, .if <br /> EH 22 013 (Rev. 02/90) <br />