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SAN JOAQUIN COUNTY �r <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE . <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: (l II III PHS-EH LOG # — <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: Telephone: !iL-�6 —on-41 <br /> Reporting Agency Name: <br /> Agency Contact: Telephone: ( -Zql �O <br /> Address: S S ,0 _=v n/l(710,-n <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: ILI144 T�:i �_ ��r r <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: ,((',n <br /> Date Notified: Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business <br /> Contact Person: `� rl r i�, � Telephoner ( 2z2�3) <br /> Physical Address: ,}rte, r l <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: <br /> 1 <br /> Chemicals: <br /> F. ACTION TAKEN <br /> 4--Drrc n .fig Ai <br /> nn /1 n <br /> + r � <br /> EH 22 013 (Rev. 02/90) <br />