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� 3 <br /> SAN JOAQUIN COUN <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:�I II III <br /> . (Circle One) PHS-EH LOG # <br /> B. SOURCE OF INFORMATION <br /> Original Source: 6i V, sabw <br /> Telephone: /G <br /> Reporting Agency Name: SGh ,► �U ��,� , <br /> Agency Contact: f�� Telephone; ( l yG �f yS <br /> Address: �G� � �4-Zz-�jr7fxc�n <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 6�O �/ �! 7�17 <br /> (Best Physical Description) / <br /> (City or County) <br /> Date of Discharge: h <br /> Date Notified: - /O - 962 Time: J <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business e,l/ <br /> Contact Person: /r �o n S v n <br /> � � Telephone: (�) <br /> Rhysical Address: <br /> E. DESCRIPTION <br /> Type Release: ZLd4o,,1z�� <br /> Volume: //r,7,4 x tV.? <br /> Chemicals: <br /> F. ACTION TAKEN <br /> T O �C. <br /> Oil�i�//Iq aS /• �� �� <br /> )P <br /> EH 22 03 (Rev. 7/89) <br /> o - <br />