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SAN JOAQUIN COUNTY V <br /> NOTIFIGtTION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 2S180.7 � <br /> A. EMERGENCYLEVEL.� Ip II III PHS-EHI�L-OG'# c1La-I-O gd <br /> (Circle One) Ib <br /> B. SOURCE OF INFORM:ATION.. i <br /> Original Source: SU DS - ('o z(y, LFu�t Telephone: 7F f <br /> Reporting Agency Name: ,Swn 'Ana Cb .PHS ; — ,, 14, 0;y <br /> Agency _ <br /> g cY Contact: _�_r4 ri��-_l "9 ; Telephone: <br /> Address: � bROXaoog <br /> 9 <br /> C. LOCATION AND DATE OF DISCHARGE i <br /> Location: C- <br /> � ti <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: ' a 90 <br /> Date Notified: 3 -,3 0 - 90 Time: 9 • 3 0 �n <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business c --��-Fi <br /> Contact Person: �27ttJ Telephone: a( Q <br /> Physical Address• 19�67_. Sf%1 G 5F-nh <br /> E. DESCRIPTION <br /> Type Release: -- le-,74 <br /> Volume: <br /> Chemicals: <br /> F. ACTION TAKEN v <br /> G( AfA;iyr <br /> a cvi , a <br /> 2 <br /> EH 22 013 (Rev. 02/90) <br />