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��•, � SAN JOAQUIN COUNTY,' j <br /> NOTIFIC' ION OF HAZARDOUS WASTE-DISI I ARGE <br /> HEALTH & SAFETY CODE 25180.7 , <br /> r A, EMERGENCY LEVEL: II III PHS-EH LOG # V21 a g <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> i,. Original Source: , /1 i PPl Telephone: /5 mak?- 7077 <br /> Reporting Agency Name: <br /> Agency Contact: siLo/ `q�� /,' Telephone: 1/S <br /> Address: 166/ <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: <br /> (Best Physical Descripti (City or County) <br /> Date of Discharge: &dj1;?01-A4 <br /> l Date Notified: :�? �, Time: <br /> o D. RESPONSIBLE PERSONBUSINESS <br /> Name of Business 0 )Ac- <br /> Contact <br /> AcContact Person: q, Telephone: <br /> U Physical Address: <br /> E. DESCRIPTION <br /> JType Release: U.Ak <br /> Volume: - ��rifi�u✓� <br /> Chemicals: - �r�z�- f x,r/e,aL� <br /> F. ACTION TAKEN <br /> f f//�i�B/ Sr le- <br /> 1ff//i?iSrrt 7>>jhC //II 11�>'TL�' nnr/f �;1'Z✓J-�/ r^J`_ <br /> II <br /> /�7t � 61e AD 6 <br /> EH 22 03 (Rev. 7/89) <br /> • �I' n <br /> 1 <br /> II <br />