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� SAN JOAQUIN COUNTY ` <br /> NOTIFIJ11-11ON 01~ I-IA:C.ARDOUS WASTE USCI-LA.RGE <br /> HEALTH & SAFETY CODE 25180.7 . <br /> A. EMERGENCY LEVEL_ - rI II r III PHS-EIS LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION : <br /> Original Source: S T Telephone: Y-'3ro' <br /> Reporting Agency Name: <br /> � I <br /> Agency Contact: 0a uf Telephone: L5 yZ< <br /> All <br /> o . 'Lod ;q S 7c�► <br /> Address: _.._.��...._,..._ , r 7!�_ , � � �� -•• —•— � <br /> C_ LOCATION AND DATE OF DISCHARGE Ole4-r EX}cO"— <br /> Location: g ;r;0sr_ <br /> (Best Physical Description) (City ounty) <br /> Date of Discharge,. <br /> Date Notified: /—/I—9 l ___ Time: D ^" <br /> D. RESPONSIBLE PERSONIBUSINL-'SS <br /> Name of Business G *or,/ <br /> Contact-,Person: _ 3 <br /> ' Telephone: 24° ) <br /> Physical Address: 640119 S�3 7 l <br /> E. DL'SCRIPTION <br /> Type Release: A- <br /> Volume <br /> Chemicals: &V a le,u V of V,o P_10 o o�S <br /> F. ACTION TAKEN <br /> _tea <br /> b d <br /> 3� <br /> EI-I 22 03 (Rev. 7/89) 4 <br />