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• SAN JOAQUIN COUNTY • <br />NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br />HEALTH & SAFETY CODE 25180.7 <br />A. EMERGENCY LEVEL: 0 I1 III PHS -EH LOG # <br />(Circle One) <br />B. SOURCE OF INFORMATION <br />Qriginal Source: ,QQ Telephone: (9_ y�o) 3 �a 7 �0 0 <br />d��iyo7 F99i <br />Reporting Agency Name: — <br />Agency Contact: 1, _ Telephoner. _ , <br />Address: - <br />C. <br />Iia <br />E. <br />LOCATION AND DATE OF DISCHARGE <br />Location: a 350 "-64/60 .Qd / SPD 4 C- A pSL <br />(Best Physical Description) it or County) <br />Date of Discharge: <br />Date Notified: Time: Spat <br />RESPONSIBLE PERSON/BUSINESS <br />Name of Business <br />Contact Person: /`QntQ C' X S4trv{�.y Teleph,ro�ne: 7U <br />Physical Address: •5a 5 W • <br />,0-� <br />DESCRIPTION <br />Type Release: --f ' <br />Volume: <br />C emicals: <br />F. ACTION TAKEN <br />FE <br />'f 3 a--3 O <br />EH 22 013(Rev. 02/90) <br />