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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> .t, <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: Ae4i I `w Res c6C Telephone: ac O7f , <br /> Reporting Agency Name: Cp S <br /> Agency Contact: - 3 y a a <br /> g �' Telephone: <br /> Address: �a 0 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 1/0 /U• 0 jSgck <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: L�.44 <br /> Date Notified: Time: O O D m. <br /> D. RESPONSIBLE PERSONBUSINESS <br /> Name of Business <br /> Contact Person: STelephone: <br /> Physical Address: /O P�'�'i �'j� G� C/4 9506? <br /> E. DESCRIPTION _ <br /> Type Release: -�/1�1L-G«�� <br /> Volume: <br /> Chemicals: <br /> F. ACTION TAKEN <br /> /D DDd r, aj Ito Cw <br /> (f <br /> w <br /> w <br /> 4v, <br /> EH 22 03 (Rev. 7/8 lam- <br />