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SAN JOAQUIN COUN . <br /> NOTIFI TION OF HAZARDOUS WASTE' 6ISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG # <br /> ucle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: Telephone: -51v2 /i <br /> Reporting Agency Name: - 11d�lir___ P�11�f, rviCS ^ <br /> Agency Contact: / Telephone: (Zoe} ) .!6a&-? <br /> Address: (� <br /> a C. LOCATION AND DATE OF DISCHARGE <br /> Location: L (o y '. JAI✓Nm ��NE / - <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: <br /> Date Notified: //}/y f 9d _ . Time: l_l <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business <br /> Contact Person: Telephone: <br /> Physical Address: 2c 6 5�rr rE.3 D CA <br /> E. DESCRIPTION <br /> Type Release: rm ox <br /> Volume: <br /> Chemicals: <br /> �J J <br /> F. ACTION TAKEN <br /> J <br /> r <br /> EH 22 013 (Rev. 02/90) <br />