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SAN JOAQUIN COUNT <br /> NOTIFICATION OF HAZARDOUS WASTE-DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVE • I II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: �cr yu �-- Telephone: 2� <br /> Reporting Agency Name: <br /> r <br /> Agency Contact: ("riog ;f- Telephone: <br /> Address: .4_,f ax. -7 A,q <3#or- CA, C, <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: qrzC) <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: ,..1 <br /> Date Notified: <br /> �5/Irio Time: _g`.30 ,/M <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business .1e1x-,,0/ ,. ,f ` <br /> Contact Person: - <br /> •'� Telephone: <br /> Physical Address: 2io <br /> E- DESCRIPTION <br /> Type Release: A4Z —4c�c <br /> Volume: <br /> Chemicals: AX:1- <br /> F- ACTION TAKEN <br /> Clime e� <br /> • 1 <br /> to � <br /> EH 22 03 (Rev. 7/89) • <br />