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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL; <br /> II TII <br /> (Circle One) PHS-EH LOG # r j ( �_i <br /> B. SOURCE OF INFORMATION <br /> Original Source: Telephone : <br /> Reporting Agency Name: a5� ., <br /> Agency Contact: , Telephone: ( avy ) <br /> Address: //o o/ P. Nom. , o �/ A „o �,/F/`� <br /> g <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location <br /> (Best Physical Description) (City or County) <br /> Date of Discharge* �tiyyciJAJ <br /> Date Notified: // - 2 i -� y Time: /o? roves <br /> Do RESPONSIBLE PERSON/BUSINESS <br /> Name of Business <br /> Contact Person: Telephone: O > 37 -03 z/ <br /> Physical Address: <br /> E. DESCRIPTION <br /> -Type Release; <br /> Volume: <br /> Chemicals: <br /> L <br /> F• ACTION TAKEN <br /> Cr / ,/ /rr ,/rI I 1 / /9 <br />: I <br /> EH 22 03 (Rev. 7/89) <br />