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n <br /> sw", SAN JOAQUIN COUNTY U <br /> NOTIFICATION OF HAZARDOUS WASTE DISCFEO,71 <br /> HEALTH & SAFETY CODE 25180.7 <br /> - <br /> A. EMERGENCY LEVEL: II III PHS E <br /> H LOG # <br /> 7�/ <br /> (Circle One) <br /> B. SOURCE OF INFORMATION _ <br /> Original Source: i HC M,&,S C. (yu41zi k Telephone: 2 <br /> Reporting Agency Name: i <br /> Agency Contact: N� L L N Telephone: (ice '"' y`'° <br /> Address: ' <br /> A o 2S D c <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 3I Yw <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: <br /> Date Notified: 8-500- Time: <br /> D. RESPONSIBLE PERSONIBUSINESS <br /> Name of Business ���/ �— <br /> Contact Person: :21-10 r-�A S 6-._ _ -t,�+l,r�i�,-Telephone: (= f <br /> Physical Address: <br /> E. DESCRIPTION <br /> Type Release: UCi1, ful LZ 1�ed <br /> Volume: N IC v-t 0 w <br /> Chemicals: <br /> F. ACTION TAKEN <br /> ' r <br /> -4-a .:. o Lru�t,y r <br /> 01?- <br /> EH 22 03 (Rev. 7/89) <br />