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SAN JOAQUIN COUNTY v <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:(D II III PHS-EH LOG # _ if„— <br /> (Circle One) �--- <br /> B. SOURCE OF INFORMATION <br /> Original Source: —jg--R__s-o/„0,�--- _ Telephone: <br /> Reporting Agency Name: � T <br /> Agency Contact: Telephone: <br /> Address. 6o r� Ave- <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 3536- e, Cherokees / r r� , <br /> (Best Physical Description) (City or County) <br /> Date Notified: a 2' ayl Time: //1,91” <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business 2)e/10��- ee,r <br /> Contact Person: _ /3,�--y c e k-9cp0/may Telephone: abs <br /> . e <br /> Physical Address: 3 S <br /> E. DESCRIPTION <br /> Type Release: � S.e <br /> Volume: .�— <br /> Chemicals: <br /> F• ACTION TAKENe,01AWMIA104 of/ 10-4k &�L-hr <br /> - �1 <br /> s <br /> EH 22 03 (Rev. 7/89) <br />