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� 1 <br /> f <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL I II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: d av0l D Telephone: <br /> Reporting Agency Name: ,?oluLlc <br /> Agency Contact: Telephone: (�y ) V&J- -3 V 6 ,p <br /> Address: _Lbc,/ f ,tea z /,�� �9 �,q qs,2o i <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: - v,,v.-- <br /> Date Notified: Time: <br /> D. RESPONSIBLE PERSONBUSINESS <br /> Name of Business <br /> �1 <br /> Contact Person: Telephone: 2o v/s-dam 70 <br /> Physical Address: <br /> E. DESCRIPTION <br /> Type Release: -Sc:,-'l s,,- o% r,� 17 <br /> Volume: 61,10;1) / �c---r, <br /> Chemicals: <br /> F. ACTION TAKEN <br /> ST :-irnova/� G t� : /yLi <br /> �l SS�SSi�o.,� c7irr0� �n ��y fPi i-r�ireo .7/2(4- eL C 0/, <br /> v—C f G Gl '/'/�=4 Gz ct <br /> L/ <br /> EH 22 03 (Rev. 7/89) <br />