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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG # Ok <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: 1p_ `� �� Telephone: ( 2Q Q ) 1_110 k— <br /> Reporting Agen Name: HS -- <br /> Agency Contact: ��ayt, Telephone: a(__ <br /> Address: R QQ C. LOCATION AND DATE OF DISCHARGE <br /> Location: ,t - / S� <br /> (Best Physical Desc ption) (City or County <br /> Date of Discharge: <br /> Date Notified: o' 7 Time: _ 11, 30a-;PPU <br /> D. RESPONSIBLE P -RSON/BUSINESS <br /> Name of Business <br /> a <br /> Contact Person: U <br /> Telephone: l /5-3/ <br /> Physical Address: a S/Z)C�� J <br /> E. DESCRIPTION C?=c <br /> Type Release: <br /> Volume: 1 <br /> c <br /> Chemicals: Z-0 �S <br /> F. ACTION TAKEN <br /> 7 <br /> Ell 22 03 (Rev. 7/89) <br />