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SAN JOAQUIN COUNTr- ' <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE (�4 <br /> HEALTH & SAFETY CODE 25180.7 <br /> v �t <br /> A• EMERGENCY LEVEL: 0 II III PHS-EH LOG # —2 <br /> (Circle One) ` <br /> B. SOURCE OF INFORMATION <br /> Original Source: (0 c� / /� Telephone: <br /> Reporting Agency Name: . i U, � , "A <br /> r PrU <br /> Agency Contact: C1 ,,,. ,/ �,L Telephone: <br /> Address: — 11,01 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 3 >/& F, /n,,,er <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: <br /> Date Notified: _ Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business - /)/ / /7?,1 ,/P �pr-- <br /> Contact Person: 770/1-7 Telephone: (2L9 ) `/6, yo <br /> 9.3 <br /> Physical Address; 271& F, <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: clip <br /> Chemicals: —. 1. e/,rte <br /> F. ACTION TAKEN <br /> Ile <br /> � r1f � ccs r>i// /,P rim c/Pf <br /> rPy i2'u <br /> v <br /> EH 22 03 (Rev. 7/89) <br />