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SAN JOAQUIN COUNTY'"s <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.' <br /> A. EMERGENCY LEVEL: 6) II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original <br /> Reporting Agenacy Name: o G <br /> Agency Contact: Telephone: (� <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 3 /J 15. <br /> (Best Physical Description) ,ty r County) <br /> Date of Discharge: -- <br /> Date Notified: -S= 9-9/ Time: <br /> D. RESPONSIBLE PERSONBUSINE, p <br /> Name of Business Ce4/'`'qac <br /> Contact Person: _ J�� Aa-� Telephone: <br /> Physical Address: z5� 5 �• of 3 D <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: <br /> CAOt-'e'N" <br /> icals: <br /> F. AT N <br /> 5J - <br /> 6)-s• 7 �Q� — &ze'a zfiP <br /> EH 22 013(Rev. 02/90) <br />