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s <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HALARDOUS WASTE DISCHARGE <br /> 1-IEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:Q II III <br /> (Circle One) PHS-EH LOG # � <br /> ....�, <br /> B. SOURCE OF INFORMATION <br /> Original Source: ! <br /> Telephone: ((a U �f-- a'p <br /> Reporting Agency Name: S — <br /> Agency Contact: Telephone: <br /> Address: <br /> f C. LOCATION AND DATE OF DISCHARGE <br /> Location: o� o ,( � � <br /> Best Ph <br /> ( ysical Description) (City or County) ' <br /> Date of Discharge: <br /> Date Notified: J S- Time: <br /> D. RESPONSIBLE PERSONIBUSINESS <br /> Name of Business <br /> Contact Person: C-jpfph Telephone: -- 3 <br /> Physical Address: 05. sa a o <br /> E. DESCRIPTION . <br /> ii <br /> `l�pe Release: <br /> Volumes <br /> Chemicals: <br /> F. ACTION TAKEN <br /> a <br /> -12 <br /> 4 <br /> 1 � <br />_ - <br /> sse s � yu <br /> EH 22 03 (Rev 89) 2. �� <br />