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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVE �I II III HS-EH LOG — <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> - ��t�, _ Telephone: ick' <br /> Original Source: �' �r� � _ <br /> Reporting Agency Name. ,.,. ,.�,r:F?'urN r! .�►.,c- �.'P<�l� r+;t� C v GAJ I�� , iv/Si�N <br /> Agency Contact: <br /> .f, >>�' elephone: <br /> , � <br /> Address: . <br /> C. LOCATION:AND DATE OF DISCHARGE <br /> Location: 2C2 q C. Cb+a <br /> (Best Physical-Description) {City r County) <br /> Date of Discharge: � <br /> Date Notified: Mme: <br /> D. RESPONSIBLE PERSON/BUSINESS - <br /> Name of Business Cur1C ha' <br /> Contact Person: <�� �/ rf�r elephone: (. cL7 ) <br /> Physical Address: Z o�y CW44 -" <br /> E. DESCRIPTION ` <br /> Type Release: �{it <br /> Volume: <br /> Chemicals: r-fies 0 <br /> F. ACTION TAKEN - //` <br /> 141 <br /> I� EH 22 013(Rev. 02/90) �. <br /> f <br />