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0 SAN JOAQUIN COUNTY 46 <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: gi2cle <br /> 1I III PHS-EH LOG # b <br /> One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: ,�U -,� Telephone: ( ) <br /> Reporting Agency Name: _ I Ps _ : ;11, <br /> Agency Contact: k 4/ , , Telephone: (,?D� ) � -3 3 pi <br /> Address: , p �( a G � �� ✓5120 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: Eoa �5, eo-i7*f / Sl tit fJ C� � <br /> (Best Physical Description) (City or County) <br /> Date of Discharge:' <br /> Date Notified: Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business Rc o - c 7 <br /> Contact Person: Gl,L r�I' �Y� Telephone: <br /> Physical Address: J <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: `"t 7 - eKn, Q <br /> Chemicals: <br /> F. ACTION TAAN <br /> �n c► - G:���- u 4 - Q' SSSS/7�z�j <br /> l <br /> EH 22 013 (Rev. 02/90) <br />