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SAN JOAQUIN COUNTY 1,4 <br /> NOTIFICATION OF HAZARDOUS WASTE DISC f <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG # i <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: ', Telephone: <br /> Reporting Agency Name: -� 1.. �� u - �. /�, Di ✓ <br /> Agency Contact: ilcolylt c ti, _. Telephone: <br /> Address: VQ C'0 '7 C ` . <br /> nsJ � � <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 3L :i_:s- F:, ,rze r,ke c <br /> (Best Physical Description) (City or County) {► <br /> Date of Discharge: <br /> Date Notified: Time: <br /> D. RESPONSIBLE PERSONIBUSINESS <br /> Name of Business <br /> Contact Person: /111 <br /> CL,� Telephone: <br /> Physical Address: <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: <br /> Chemicals: <br /> F. ACTION TAKEN <br /> �'L _ CG�tiLtLt/Li ( s•�ess lhC�'L <br /> EH 22 <br />