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r. <br />SAN JOAQUIN COUNTY <br />NOTIFICATION OF HAZARDOUS WASTE'DISCHARGE <br />HEALTH & SAFETY CODE 25180.7CO <br />rs <br />A. EMERGENCY LEVEL: 0 II .III PHS -EH LOG # <br />(Circle One) <br />B. SOURCE OF INFO TION <br />Original Source: IA -55n( -A . Telephone:)�?Sa <br />j'�LQ,1 <br />Reporting Agency Name: ul <br />Agency Contact: Telephone: (?) 2 <br />Address: LAA vi`Tc�c <br />C. <br />E. <br />F <br />LOCATION AND DATE OF DISCHARGE <br />Location: <br />(Best Physical Description) (City or County) <br />Date of Discharge: (<41 Uh2D <br />Date Notified: ?2` /— �9 W <br />RESPONSIBLE PERSON/BUSINESS <br />Name of Business <br />Contact Person: f <br />Physical Address: a. n <br />DESCRIPYAON <br />Type Release: <br />A!`T OV TAKEN <br />Time: - <br />Telep ane: O <br />C,, Gam— 02 <br />EH 22 013 (Rev. 02/90) <br />