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'AN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE U1SC BARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II III QS <br /> =EHYLG # <br /> ircle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: ���-? ���� o Telephone: ( toy) P-,) <br /> Reporting Agency Name: Ce S <br /> Agency Contact: r��«v/ o c— Telephone: ()-of ) y&j= <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: <br /> Date Notified: /i- y - ef-D Time: <br /> D. RESPONSIBLE PERSON/BUSIN/ESS <br /> Name of Business 4 le - <br /> Contact Person: /rl�z(,P Tele hone <br /> P (_� <br /> Physical Address: sus r i� _ Gv s 4,�a�>/� 5 c, ao i <br /> E. DESCRIPTION <br /> Type Release: - <br /> Volume: / �2 12lK, cis -,<i/ - <br /> Chemicals: Z-e7 s ---F. ACTION TAKEN <br /> c-G7 -111E's-- .St <br /> ^1-P n-F c C S Sa c c Tv G�P f t-=r Cyt r wP <br /> G9ro Fzc� <F C,X' �[ rT cJ� u rfc<., c rvc�Y r cr <br /> Gccc-5 is e <br /> EH 22 013 (Rev. 02/90) <br />