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_ •_ SAN JOAQUIN COUNTY <br /> NOTIFIC I`ION OF HAZARDOUS WASTE-&SCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: 91rcle- <br /> II III PHS-EH LOG # <br /> One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: Telephone: ( 411:;- <br /> Reporting Agencyame: L i 'C� '` r C <br /> Agency Contact: LEI je, Telephone: S <br /> Address: <br /> C. LOCATION ANDDATE DISCHARGE <br /> Location. - <br /> "` ti rip ion (City or County) <br /> Date of Discharge: D <br /> Date Notified: t Z5 Time: vyk <br /> 00 <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business <br /> Contact Person: r net [�J�nU_ Telephone: <br /> Physical Address: <br /> E. DESCRIPTION <br /> Type Release: <br /> v <br /> Volume: < ^� <br /> Chemicals: <br /> F. ACTION TAKEN <br /> EH 22 013 (Rev. 02/90) <br />