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SAN JOAQUIN COUNTY <br /> NOTIFICH� ON OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> v" <br /> �} <br /> � <br /> L <br /> A. EMERGENCY LEVEL:0 H III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: <br /> Telephone: <br /> za <br /> Reporting Agency Name: <br /> Agency Contact: - _�—=- Telephone: <br /> Address: <br /> C. LOCATION AND DATE OF DISCI-TARGE <br /> Location: a5 �� 5 S , a on P.SS/ <br /> a <br /> (Best Physical Description) <br /> Date of Discharge: I,(M (City o County)D� 1�� <br /> Date Notified: <br /> D. RESPONSIBLE PERSON/BUSINESS Time: <br /> Name of Business �-c� 19 <br /> Contact Person: � Telehone: <br /> Physical Address: ( � – � . <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: --A!a12 <br /> Chemicals: <br /> F. ACTION TAKEN U <br /> O -Q <br /> EI-I 22 013 (Rev. 02/90) {� <br /> "�la_�b-vim., �p�, P rP.� ,✓�a �A-o�_ ��� /U�wLA, ,pE.�ti2 <br />