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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 2518U.7 <br /> A. EMERGENCY LEVEL: II III PHS-EH LOG # "h2 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: a `'�, Telephone: (A ? G`/S <br /> Reporting Agency Name: <br /> Agency Contact: � Telephone: o- S s <br /> Address: P-0. 3& ' U <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 7J63, <br /> (Best Physic Description) (City or County) <br /> Date of Discharge: -��� <br /> Date Notified: / Time: •7 �. <br /> D. RESPONSIBLE PERSONIBUSINESS <br /> Name of Business <br /> Contact Person: Telephone: /S y-c 7L �t'Zv3 <br /> Physical Address: .17-1 ti <br /> E. DESCRIPTION - 6 r4 clh <br /> Type Release: PA n <br /> Volumes <br /> ChemicalstAKEN <br /> F• ACTION <br /> leer" _ <br /> EH 22 03 (Rev. 7/89) ' <br /> • 1 <br />