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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: 5 II I11 PHS EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: �/'/�c�s�c� ,�sf f-es�t Telephone: <br /> Reporting Agency Name: ro- <br /> Agency Contact: Telephone: (,22E ) <br /> Address: `fY-5,- ti- Toe amu,. <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: l7i/ ef- yo se•;�, ,'/e / <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: �w^--- <br /> Date Notified: Time: <br /> D. RESPONSIBLE PERSONBUSINESS <br /> Name of Business <br /> Contact Person: lC,17,1-7 5 i Telephone: 5 -- yy q <br /> Physical Address: S/S ������- �f. L��s ��� e l�_S % C2v 7/ <br /> E. DESCRIPTION <br /> Type Release: z e <br /> Volume: -- <br /> Chemicals: <br /> F. ACTION TA/KEN <br /> sIrLGc ti P dw <br /> 17 <br /> EH 22 013(Rev. 02/90) <br /> SWEEPS/SITE CODE <br /> CONT. MFR: / N <br /> REFERRAL TO: <br />