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5..,4 JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG # <br /> (Circle One) <br /> � <br /> B: SOURCE OF INFORMATION <br /> Original Source: K ti LF ; Telephone: O ` i//— �7// <br /> Reporting Agency Name: u„r' Gail fCAC.7�f Sv�c�� r h-�D <br /> AgencyContact: lit/,'G sui• Telephone: <br /> Address: . o , (3ivy c� C CIS. <br /> G LOCATION AND DATE OF DISCHARGE <br /> Location: j1Fo6e ets ,fid! S�vGi�Lam.✓ Gam- ��LD,� <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: <br /> Date Notified: Time: <br /> D. RESPONSIBLE PERSON/13USINESS <br /> Name of Business ,Q�4h <br /> Contact Person: A.) Telephone: <br /> Physical Address: �S . Ra e6a e <br /> E. DESCRIPTION <br /> Type Relo-nse: <br /> Volume: U Cvrd � <br /> Chemicals: u ,e�UtiS <br /> F. ACTION TAKEN <br /> d V r✓ re j^,Jc{ <br /> LL e �2 de,A n� <br /> EI! 22 03 Rev. 7/89) <br />