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Y <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:IJ II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: „w.� TeIephone: (20G) " 3 <br /> Reporting Agency Name: <br /> Agency Contact: Telephone: (_} <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: `S �". I <br /> (Be t P ysical Description) (City or County) <br /> Date of Discharge: 4 L n <br /> Date Notified: 91-2-41pluTime:. G <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business <br /> Contact Person: O lV Telephone: ( _} <br /> Physical Address: <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: <br /> Chemicals: te, j - <br /> F. ACTION TAKEN <br /> Y1 Cb <br /> � CT 41 - <br /> EH 22 013(Rev. 02/90) <br />