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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> IIEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: Naha Telephone: oa( o f ) <br /> Reporting Agency Name: S�- -P <br /> Agency Contact: &OYL"LTelephone: (�C� C,f- — 3 �� <br /> Address: A4 L SLG C 1019 9 soZ 0 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: j <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: q <br /> Date Notified: '/(1 q Time: all, <br /> D. RESPONSIBLE PERSONBUSINESS <br /> Name of Business __; <br /> Contact Person: `' <br /> Telephone: () <br /> Physical Address: n 4L. <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: <br /> Chemicals: _; <br /> F. ACTION TAKEN <br /> a <br /> ZL=�� <br /> EH 22 03 (Rev. 7/89) ! lti � �,• <br />