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SAN JOAQUIN COUNTY <br />NOTIFICATION OF HAZARDOUS WASTE LISCHARGE <br />HEALTH & SAFETY CODE 25180.7 <br />A. EMERGENCY LEVEL:I II III PHS -EH LOG # �D - a U D- <br />'rcle One) <br />B. SOURCE OF INFORMATION <br />Original Source: Telephone: (a�)�v� <br />Reporting Agency Name: �' S ° <br />Agency Contact: C Tel phone: ( ) �� _� �y <br />Address: 9'. S <br />C. LOCATION AND DATE OF DISCHARGE <br />Location: <br />(Best Physical Des ription) (City or unty) <br />Date of Discharge: 7/— T4- �� <br />Date Notified: l ) 5 — 90 Time: 1 � D. RESPONSIBLE PERSON/BUSINESS <br />Name of Business _. <br />Contact Person: ,%�L/IrI`C� yn- Telephone: <br />Physical Address: J <br />E. DESCRIPTION <br />0 <br />Type Release: <br />Volume: D ADD <br />Chemicals: <br />F. ACTION TAKEN <br />A Ad <�, zv -fft,� <br />SQ Ta <br />IJLI 1%!/ <br />EH 22 013 (Rev. 02/90) <br />