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SAN JOAQUIN COUNTY <br /> NOTIFIC.,-TION OF HAZARDOUS WASTE DISCI-TARGE <br /> HEALTH & SAFETY CODE 2S180.7 <br /> r rn) <br /> A. EMERGENCY LEVEL: 11 III PHS-131-1 LOG # �l?,�O $d <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: Su DS Telephone: <br /> Capt <br /> Reporting Agency Name: <br /> Agency Contact: ` <br /> Telephone: <br /> Address: Pio, 0-106(? S <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: _/�&,� �� �� / S'-7n C <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: - a / v 90 <br /> Date Notified: _ 3 - - 1-) Time: - 9 aim <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business �� <br /> Contact Person: I <br /> Physical Address. <br /> E. DESCRIPTION <br /> 1ype Release: <br /> Volume: — l qa,Q <br /> Chemicals: <br /> F. ACTION TAKEN <br /> Aowv <br /> yzw <br /> EI-I 22 013 (Rev. 02/90) <br />