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i I <br /> a <br /> SAN JOAQUIN COUNTY <br /> NOTIFI ?TION OF HAZARDOUS WASTE"DISCHARGE Q <br /> HEALTH & SAFETY CODE 25180.7 i <br /> _ II <br /> p Pr 1 <br /> A. EMERGENCY LEVEL I II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: �eS �'3L, <br /> Telephone: (�� +10e. 3�6ell <br /> Reporting Agency Name: a <br /> Agency Contact• Telephone: �ffQ „ 3 YL. <br /> Address: <br /> C. LOCATION AND'DATE OF DISCHARGE ,, <br /> .. <br /> Location: j q 6 q <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: <br /> I <br /> Date Notified: t�/�� { <br /> Time: �4Q tyv <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business <br /> Contact Person: <br /> Telep ane: <br /> Physical Address: 24 <br /> 4 ' <br /> E. DESCRIPTION C&I ' � 7 C . ; <br /> Type Release: t <br /> Volume: ^„ <br /> Chemicals: ; <br /> F. ACTION TAKEN <br /> V,0,0k <br /> Of <br /> i <br /> E <br /> EH 22 03 (Re . 7/89) I'4 <br />