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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL; 0IIIII <br /> (Circle One) PHS-EH LOG # �� 7 <br /> B. SOURCE OF INFORMATION <br /> Original Source: T , Z � S - I <br /> Telephone: (J�6 ) <br /> Reporting Agency Name: , <br /> Agency Contact: ��/_rgy���� Telephone: (�j ) Y6 3 YSy <br /> Address: r <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: W- Z Nfi" <br /> —I9� Cn/��.� / <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: ��n //�/�✓`/ <br /> Date Notified: //- Time: <br /> ( D• RESPONSIBLE PERSON/BUSINESS I <br /> Name of Business (` c� <br /> Contact Person: o P �� /� Telephone: <br /> Physical Address: <br /> E. DESCRIPTION <br /> Type Release: C dei 3//SSr �yic ln�s�x� C/,j nZ11cu�is i f `l , <br /> VoluraS: s nJ c. r — � /Ci�C.Sc <br /> Chemicals: //�' � <br /> F. AACTIION TAKEN <br /> 17 <br /> � <br /> -F•-1 P Y3,� �/v/Je/LLY I C2i 1U�i-s�C t�lsJrocl7�.y <br /> EH 22 03 (Rev. 7/89) <br /> �_i-1 <br />