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SAN JOAQUIN <br /> COUNTY <br /> NOTIFICATION OF `k J <br /> HAZARDOUS!;WASTE DISCI_1ARCE <br /> HEALTH & SAFETY CQDE 251$0:7. <br /> ..;A .1 <br /> A. EMERGENCY LEVEL: .I II III EI <br /> (Circle One) <br /> PHS-EH LOG # 171 <br /> � B. SOURCE OF INFORMATION <br /> l Source: Ek <br /> s TeIephone. <br /> Re <br /> porting Agency Name: <br /> Agency Contact: , 711} <br /> Telephone: �1 <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: '�7i ;# �3! ssc :l �� � , R - ! b I 5A16 _-J_b <br /> (Best Physical Description) x '(City.or 1 <br /> F , ,.5 w County) ii �! <br /> s ate of Discharge:,, <br /> o;y' <br /> Date Notified: <br /> _ Time. ., t <br /> D. RESPONSIBLE PERSON/BUSINESS t r W <br /> Name of Business s "It'�►9yZ: Vnst� <br /> f: Contact Person: .. <br /> Tehpinne• < <br /> 41 <br /> Physical 3 <br /> y al Address <br /> E. DESCRIPTION <br /> • � � : �' �l. �� � ;lam <br /> ` Type Release: <br /> Volume: is <br /> Chemicals: yJ 1 � '1 <br /> F. ACTION TAKEN F 7 ` <br /> r; , t• <br /> wu' �, r� ' 1 <br /> i EH 22 03 <br /> Rev. 7/89) ,, } <br />