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� E <br /> �` SAN JOAQUIN COUNTY .►l <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHAR O <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG # ld -' D e-19 <br /> (Circld One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: /u.�f �- ����� t Telephone: <br /> Reporting Agency Name: irlyOc9e'i:. <br /> Agency Contact: �'C��o/ d z_ Telephone: (2,2,.- <br /> Address: <br /> plAddress: fg 9s�c�� <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: g,- s L , <br /> c„ / -- /J?c.nG4- <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: <br /> Date Notified:Notified: ;2-,9?6 - gy Time: i0=.9��► <br /> D. RESPONSIBLE PERSONBUSINESS <br /> Name of Business <br /> Contact Person: _ /�i.rcPs �, T`i ,,rtes Telephone: <br /> Physical Address: -- 2 9O/ <br /> r <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: <br /> Chemicals: �� P <br /> F. ACTION TAKEN <br /> 14 , <br /> f?fi LCz.io <br /> ms's r�/fi/l!i E liO�ii v <br /> EH 22 03 (Rev. 7/89)' , <br />