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tl• ZA'a`P <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCI.IEIRGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I" II III PHS-EI-1 LOG # <br /> irclE One) <br /> B. SOURCE OF INFORP4ATION <br /> Original Source: — Y Telephone: (&e <br /> Reporting Agency Name: Ak <br /> Agency Contact: j �. Telep.ione: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: /aic s- <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: <br /> Date Notified: - a Time: 9Am <br /> 1). RESPONSIBLE PERSON/BUSINESS <br /> Name of Business _ cz. <br /> Contact Person: Telephone: O _ 9 y <br /> Physical Address: 5,1 9s_-?66 <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: <br /> Chemicals: <br /> F: ACTION TAKEN <br /> EH 22 013 (Rev. 02/90) <br />