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SAN JOAQUIN COUN"1'Y <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> C(DPY.� <br /> A. EMERGENCY LEVE - I II III PHS-EH LOG # <br /> 90-r �l <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: ��1�t �e, Telephone: , <br /> Reporting Agency Name: i n 1„A ivI c. 14-1q,,( j co%raec. <br /> i <br /> Agency Contact: arW -4U r Telephone: 2Q2 <br /> Address: E n. _..rteq ..e <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: ,14W_A ,&- —&t ;= <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: _��:N <br /> Date Notified: 1 210 120 <br /> Time: ----- <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business �'�•�, 4��.. -a, s <br /> Contact Person: r 1�e F^ota(r1- Telephone: (sal <br /> Physical Address: I jqq Ntor i.�* C%� pc4 <br /> E. DESCRIPTION ' <br /> Type Release: <br /> Volume: <br /> Chemicals: t'?-o j�uyr ,r�cc,r�ti•as <br /> F. ACTION TAKEN <br /> S'f' lMk. a . <br /> aAwrl <br /> J 1/ <br /> EH 22 03 (Rev. 7/89) <br />