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SAN JOAQUIN COUNTY 0 O <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVE II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: A7 <br /> Telephone: <br /> Reporting Agency Name: 5q,v <br /> Agency Contact:C�i��/o� //// <br /> �C�^'� <br /> Address: Telephone: <br /> � C � <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: $ 3 C-- St <br /> (Best Physical Descri tion <br /> p � (City or County) <br /> Date of Discharge: ��, A <br /> Date Notified: <br /> � Time: <br /> D. <br /> RESPONSIBLE PERSON USINESS <br /> Name of Business / <br /> Contact Person: , <br /> Telephone: �— <br /> Physical Address: g?3 FIA <br /> rpt <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: f <br /> Chemicals: P-- <br /> F• ACTION TAKEN <br /> yie01. <br /> f�►Pi`' Sri �r-� - <br /> r n <br /> V <br /> v <br /> EH 2203 (Rev. 7/89) <br />