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ft <br /> SAN JOAQUIN COUNTY NOTIFICATION OF HAZARDOUS WASTE DISCI-IAR OP <br /> HEALTH & SAFETY CODE 25180.7 <br /> � UUU <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> C?'iio <br /> Original Source: L Telephone: (,,!% 5,16ef-�`//a z <br /> Reporting Agency Name: iir <br /> Agency Contact: Cis o/ 62 Telephone: y) YHA <br /> Address: 16vi f_ l , F// , x c Fug, 95 0/ <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: /l?c,r.Seca C4-- <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: <br /> Date Notified: Time: i0."ter <br /> D. RESPONSIBLE PERSON/I3USINESS <br /> Name of Business �c•.� <br /> Contact Person: - „nPs 7/ ,,,lam Telephone: ( 329 ) Js <br /> Physical Address: .l901 f L•, „s %- <br /> E. DESCRIPTION <br /> Type Release: ..,?!-.. <br /> Volume: zzzi <br /> Chemicals: <br /> F. ACTION TAKEN <br /> F- •O �/a- s•.<P iv 5 SSSS f 7 l� dC I2CC ESS/J 4 'YO �� <br /> EH 22 03 (Rev. 7/89) <br />