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- ,;AN JOAQUIN COUNTY *- <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> lb <br /> A. EMERGENCY LEVEL: Q II III PHS-EH LOG # 22. <br /> (Circle One) <br /> B SOURCE OF INFORMATION <br /> Original Source: - D e Telephone: Za9 ) <br /> Reporting Agency Name: OGT x4req!/4 <br /> Agency Contact: „-o O �� Telephone: (Ze;7 ) <br /> Address: <br /> C LOCATION AND DATE OF DISCHARGE <br /> Location: too E z7?arw .5�• � '�',!z`c /�•• C/� <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: <br /> Date Notified: 3 - Time: /a'r'm'.• <br /> D RESPONSIBLE PERSON/BUSINESS <br /> Name of Business <br /> Contact Person: �✓,/ce Telephone: (2 4" 77 -��f 7 <br /> • Physical Address: �S'oy f3o�� •r-��� ��'- S�ErC4 9 saw 7 <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: c e7,,z <br /> Chemicals: <br /> F ACTION TAKE <br /> o s Vee- S i// Cfsslt c. <br /> l.a� of C •, .- �rcrs r .....ter/ Ar c, .� tr c�l�E>�• <br /> r►< �1 i�>f n 3 ����` C'it✓C' / c�rj rr'«n i! SGrrr r _n j- <br /> 4— > �rY �r'r+.s t t• F7 <br /> v / L <br /> '. EII 22 013 (Rev. 02/90) <br /> a <br />