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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG # 9�r / 72 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION c <br /> Original Source: ?'r eUel- v/} Telephone: �' /./j <br /> Reporting Agency Name: Son <br /> Agency Contact: Z/Ca✓I0,1 Telephone: Z�^i 6 3 <br /> Address: 1y� S�� JG°'a1 v ' kj <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 3 0s /�/ (/r�,t / 4.'I cs <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: v', /i1 a <br /> Date Notified: 2 �/- �! Time:D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business . �`'� )< <s <br /> Contact Person: cd Telephone: <br /> Physical Address: <br /> SOU� �,✓ <�i�,�-/ /�l//�r 1 �s �5 3 -� < <br /> E. DESCRIPTION <br /> of �✓ Ly//���1�/�� Tr' � �C�v97`�/t'd U�� ��(���V�;S <br /> Type Release: S��' G '°�n `�� U <br /> Volume: v� ���v�✓n <br /> Chemicals: <br /> F. ACTION TAKEN / / / <br /> `j l�j rf0 m/l��%✓I �`i ri/� G 5 S r 0 LP', <br /> j✓� � rlg �� hL �i r iron ` �l . f—vr�h C/ <br /> 74 <br /> EH 22 03 (Rev. 7/89) j�� <br />