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. k i <br /> L <br /> SAN JOAQUIN COUNTY \V, <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: II III PHS-EH LOG # <br /> Circle One <br /> B. SOURCE OF INFORMATIONN <br /> Original Source: ` 'Q, RLSC64— Telephone: <br /> Reporting Agency Name: S0,411 a P S /—C-. <br /> Agency Contact: - 90�v Telephone: 20.0 yca <br /> Address: P, 0, <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: <br /> ._3 S-3 :5 <br /> {Best Physical Description) (City or County) <br /> jt <br /> Date of Discharge: <br /> Date Notified: Time: 4 LO 0&fit,.1 <br /> D. RESPONSIBLE PER/SnO-N/BUUSINESS <br /> Name of Business <br /> P�it�� <br /> Contact Person: e& g*zzl , Telephone: {�►b q) (p rp /(o <br /> Physical Address: �v f' ,�o? <br /> E. DESCRIPTION T <br /> Type Release: <br /> Volume: <br /> Chemicals: <br /> F. ACTION TAKEN <br /> 09 <br /> ,loon <br /> a. <br /> SeS.S V <br /> EH 22 03 (Rev. 7/89) �P ' <br />