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4 1 <br /> J _ <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 y <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: . 2d 3S .5174 <br /> �? Telephone. <br /> Reporting Agency Name: gL <br /> Agency Contact: Telephone: <br /> Address: ` <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: �1.i. <br /> (Best Physical Description). � (City or Cou ty) <br /> I' S; <br /> Date of Discharge: a✓,✓`'1 1 1;1:. <br /> Date Notified: Time; <br /> D. RESPONSIBLE PERSON/BUSINESS ti <br /> r r r <br /> Name of Business <br /> Contact Person: lli✓ Telephone: <br /> Physical Address: 3 �`re �J��N e I'! X376 <br /> E. DFS 14 <br /> Type Release: U ;: <br /> Volume: 0A1�� �✓rt <br /> Chemicals: Wed YDS g: <br /> F. ACTION TAKEN <br /> r <br /> ew <br /> EH 22 03 (Rev. 7189) <br /> i , <br />