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SAN JOAQUIN COUNII . <br /> TIF1�TION OF HAZARDOUS WAS DISCHARGE - r <br /> HEALTH & SAFETY CODE 25180.7 = <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG # <br /> ucle One) <br /> B. SOURCE OF INFORMATION Telephone: <br /> Original Source: f r <br /> Reporting Agency Name: S <br /> Agency Contact: / Telephone: ( 202) Sr <br /> Address: 5 <br /> C, LOCATION AND DATE OF DISCHARGE <br /> Location: LALL E, q RMM nr5- .._ l <br /> (Best Physical Description) (City or County} <br /> Date of Discharge: <br /> Date Notified: Z!}/ /M _._ Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business 02 at- Liltea&y <br /> Contact Person: r' Telephone: <br /> Physical Address: 2osP ,moi rE 3 O 64 <br /> E. DESCRIPTION <br /> Type Release: " m'' <br /> Volume: <br /> Chemicals: J <br /> F. ACTION TAKEN <br /> r / - <br /> EH 22 013 (Rev. 02/90) <br />