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SAN JOAQUIN COUNTY <br /> NOTIFFICATION OF PIAZARDOUS WASTE DISCHARGE <<105-) <br /> HEALTH & SAFETY CODE 25380.7 <br /> A. EMERGENCY LEVEL: <br /> (Circle One) (D II III PHS-EH LOG # d <br /> B. SOURCE OF INFORMATION <br /> Original Source: —tLaio /Q�� Telephone: <br /> Reporting Agency Name: - <br /> f <br /> Agency Contact: � /�!e Se ices <br /> �a ��_ Telephone: (�� ) Z - <br /> Address: 1,6n.., <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 353 cam, <br /> (Best Physical Descri tion <br /> P ) (City or County) <br /> Date of Discharge: <br /> Date Notified: — -a 2L L7 Time: 111.91" <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business <br /> Contact Person: lace �o�/�se�y Telephone: <br /> Physical Address: 3 6 3 _ <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: <br /> Chemicals: a e&v z4Xq, <br /> F. ACTION TAKEN <br /> _ 0 <br /> G <br /> EH 22 03 (Rev. 7/84) <br />