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WJOAQUIN COUNTY ft <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: 0 II III PHS-EH LOG # I <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: Telephone: <br /> Reporting Agency Name: <br /> Agency Contact: � o Telephone: <br /> Address. .�. '� <br /> C. LOCATION AND DATE OF ISCHARGE <br /> Location: - �?tz l <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: - ��� el <br /> f� ' 3 � <br /> Date Notified: �� f Time: � <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business l _ ` ' C� C fAi <br /> Contact Person: Telephone: ( �) <br /> Physical Address: � '� LW 9 � <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: i�-1�f2✓'c1 : �'�� <br /> Chemicals: k, At r z '• `'`" �- G�nr� <br /> F. ACTION TAKEN <br /> 911 �J�d d <br /> �`�2 ter!��. J' G�✓iG � �� S,–C—S:t CSS C�S�� l'hG a��� i LC �/� <br /> r <br /> A <br /> EH 22 013 (Rev. 02/90) <br />