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SAN JOAQUIN COUNTY) <br /> NOTIFICATION OF HAZARDOUS WASTE DISC <br /> � r <br /> ;'1 <br /> HF-AI.T1-i & SAFETY CODE 25180.7 �../ <br /> A, EMERGENCY LEVEL II III <br /> (Circle One) <br /> PHS-EH LOG # D— 0 z� <br /> "s <br /> B• SOURCE OF INFORMATION <br /> Original Source: Telephone: (24 � )r <br /> Reporting Agency Name: � fvu h. . <br /> Agency Contact: Telephone: (,?c <br /> Address: I- M <br /> C. LOCATION AND DATE OF DISCHARGE <br /> i <br /> Location: •..�C?.�o �10K) _,_... <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: NvwrJ <br /> Date Notified; [ Time: 40 <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business <br /> Contact Person: TeIephone; `zl 30 <br /> Physical Address: <br /> E, DESCRIPTION <br /> Type Release: A V_ <br /> Volume: <br /> Chemicals: <br /> { <br /> R ACTION TAKEN s <br /> t- ,WW <br /> nw P <br /> EH 22 03 (Rev. 7/89)' <br /> 4 <br /> i <br /> I <br />