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i <br /> d � . w - F •"moi , <br /> SAN JOAOUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL&I II III PHS-EH LOG # S 9 a 3 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br />! <br /> Ori inal Source: — <br /> g Lo Telephone: <br /> Reporting Agency Name: S&17 , _:.}? <br /> Agency;Contact: 4Telephone: {_ C� <br /> Address: P C <br />. it <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: # cth _-60 LO ""' <br /> (Best PhysicM. Description)J (City or County) a <br /> Date of Discharge: LG �,"> - <br /> Date Notified: /111"71 Time: r <br /> D. RESPONSIBLE PERSON USINESS <br /> Name of Business v <br /> Contact':Person: `��t` Telephone: 6,(na a G — <br /> PhysicalAddress: t <br /> k <br /> E. DESCRIPTION <br /> Type Release: C�-C <br /> Volume: <br /> Chemicals:': 1'LC -_�7 <br /> F. ACTION TAKEN i <br /> Dc <br /> k <br /> 4 + - <br /> S, , k <br /> OF <br /> EH 22 0 (Rev. 7/89) <br />