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Qj <br /> SAN JOAOUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 2S180.7' <br /> A. EMERGENCY LEVEL: II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: �t,tQ+ r�ta laS' tJC_ Telepfione: Q l +) �" <br /> Reporting Agency Name: y <br /> Agency Contact: Tele <br /> �L. phone: <br />'! <br /> Address: <br /> ` i�� <br /> C. LOCATION ANDDATE OF DISCHARGE <br /> ii <br /> Location: d� i � � a. el- �i <br /> tL S�rJ CYa wi tJ <br /> (Best Physical Description) (City 1ior C 1 unty) <br /> Date of Discharge: LA ti <br /> Date Notified: e , Time: �! <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business <br /> 11 <br /> Contact Person: Teleph'ane: j' ?c 0 <br /> QPh <br /> Physical Address: 10 � . �� <br /> c C' <br /> E. DESCRIPTION <br /> ` I ail <br /> Type Release: CoQ Fv+2�.(,0_; <br /> i Volume: <br /> Chemicals: <br /> F. ACTION TAKEN <br /> (.r l em-iw(51) , `I'- Gnti- l�c�fL6 C S i't ' -. rir1PLl57 <br /> EH 22pbp7/$ }�`' �L�lui2� i`�.�C�� <br /> cv- So `� I! <br />