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SAN JOAQUIN COUNT)' ;) <br /> NOTIF�ATION OF HAZARDOUS WAS TDISCHARGE(C <br /> HEALTH & SAFETY CODE 25180.7 O <br /> A. EMERGENCY LEVEL- II III `' PHS-EH LOG # <br /> qa -- d 7 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> i <br /> Original Source: Ido beA4 Telephone: Ze J?35- �L�3 <br /> Reporting Agency Name-,5,+/'/ c7� ti t:J (�, u �1,� l4FA L,r14, S F —Vic <br /> Agency Contact: :;L)bnl,,rA r4 Telephone: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: I__ _ .f26 t <br /> Best Physical Description) Ci or Count <br /> 1J�✓!cs-Lawn/ ` <br /> Date of Discharge: s <br /> Date Notified: � Z'3,�a1 � �� Time: �: a� � '"'t � <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business <br /> Contact Person: bee Telephone: (-J,421 , 9?r--7*A& <br /> Physical Address: x.11—. ., ft'N�G.�✓� ,��r�. �2 �—'2 C `T S'37, i <br /> E. DESCRIPTION I / <br /> Type Release: <br /> Volume: <br /> / F 3 <br /> 7 <br /> Chemicals: <br /> e 7�"a /ter.► Gi v �f Y p c�,4,2 b a .✓s � i; <br /> F. ACTION TAKEN r <br /> Sa �G a.,.. w��-- Q.�..- / . r�su/r� r�✓ems ��w�ih�.� <br /> . <br /> .a <br /> 6 9D , r S "ode aSSesS1� ",� �✓.�/ .dQ ti ll- <br /> `'-e, ( <br /> EH 22 03 (Rev. 7/89) - <br /> a � � <br />