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SAN JOAQUIN COUNTY_ <br /> " NOTIFICATION OF HAZARDOUS WASTE DISCHARGE . <br /> i <br /> HEALTH & SAFETY CODE 25180.7� HE <br /> A. EMERGENCY LEVEL: 10 1, III ;. . PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFO NlknON �l Q <br /> Original Source: Telephone: <br /> Reporting Agency N e: ; <br /> Agency Contact:". 2 elephone: <br /> Address: - <br /> C. LOCATION AND DATE FDISCF GE <br /> Location: <br /> h <br /> J <br /> (Best Physical Description) " (City or County) t - <br /> Date off Discharge: - <br /> Date Notified: a Time: <br /> D. RESPONSIBLE,PERSON/BUSINESS <br /> Name'of Business <br /> Contact Person: . / - j Telephone: ( S <br /> ���d moo[ S -fie l�-Sa A <br /> Physical Address: <br /> E. DESCRIPTION' <br /> it + <br /> Type Release: <br /> Volume: <br /> Chemicals: . <br /> F. ACTION TAKEN <br /> EH 22 013 (R v. 02/90) �//C}���'/�fy/�/[�/vt 6� `Sw/C <br /> �9 <br />