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SAN JOAQUIN COUNTY CV) <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> Cl0 <br /> A. EMERGENCY LEVEL: PHS-EH LOG # <br /> (Circle One) ' <br /> B. SOURCE OF INFORMATION <br /> Original Source:, /fie ��1� Telephone: <br /> Reporting Agency Name: <br /> ��i� � - <br /> Agency Contact:e,-'-_7 �,7�� �� Telephone: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: ��5 ,(�j/dam ,�� C <br /> (Best Physical'Description) (City or Count <br /> Date of Discharge: <br /> Date Notified: — / 8 w Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business �Olyeiew <br /> Contact Person: Z5 Telephone: c�� ) Y6 - ":�-4 d <br /> Physical Address: - 6CO ��vr> ✓1 d%;P /�,,e Cir ��.��, �� <br /> E. DESCRIPTION <br /> Type Release: ���' (,'OL*7 •��: �� n� ///�c/c_o1 ,�, 'v�� <br /> Volume: - ii.?,��o ✓� <br /> Chemicals: %/l 1P kz),1e6z,-i /i I/,- <br /> F. ACTION TAKEN II <br /> _lf'Tti✓✓Y//�iC_ TG�c' X��s%� C�� f'�i%7�-�n�/'���� <br /> 11-2 <br /> EH 22 03 (Rev. 7/89) <br />