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SAN JOAOUIN COUNTY <br />NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br />HEALTH & SAFETY CODE 25180.7 <br />A. EMERGENCY LEVEL: DI II III PHS -EH LOG # <br />(Circle One) <br />B. SOURCE OF INFORMATION <br />Original Source: Oin <br />Reporting Agency Name: - -) I <br />Agency Contact:& �- \ <br />Address: <br />i /�)lr--- <br />Telephone:% �{-,; , <br />> 1yo <br />_ <br />Telephone: -?,,j) ,k rR <br />C. LOCATION AND DATE OF DISCHARGE <br />Location: Q,nen Tf�\/ I ► � (l ��j�-�� <br />(Best Physical Description) (City or County) <br />Date of Discharge: L l-) k rown <br />Date Notified: Time: i (r'. <br />D. RESPONSIBLE PERSON/BUSINESS <br />Name of Businessr, <br />Contact Person: (__ o Uh Telephone: ( T I <br />Physical Address: j <br />E. DESCRIPTION <br />Type Release: i . ✓ n. ,� ��, r } �(,, <br />Volume: t) n Lt-)Ou Y-) r 77 d .a <br />Chemicals: _ On��! �) <br />F. ACTION TAKEN J <br />no -I n <br />EH 22 03 (Rev. 7/89) . <br />