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1 ' <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:@ II III PHS- <br /> EH LAG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: ,e/n(' � �S i � /� Telephone: <br /> Reporting Agency Name: S <br /> Agency Contact:4%CG/1o/ ��/,'�j� Telephone: ( l } >116 c�--3 yS <br /> Address: /-zt/ 17S'Se?U <br /> C. LOCATION AND DATE OF DISCHARG <br /> Location: G 2 / i�,� �� >``✓� <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: //✓���'1G�✓� <br /> Date Notified: Time: <br /> D. RESPONSIBLE PERSON/BUSIN S <br /> Name of Business <br /> �. y <br /> Contact Person: Telephone: <br /> Physical Address: /0 7l,2 <br /> E. DESCRIPTION V�roba�ri <br /> Type Release: r` oi�1f.,9 ✓� �U�T�I�C� ��r�� SU- <br /> Volume: <br /> Chemicals: d / 1e4y/e�,,7 `rY��✓c"eG%�r�5 ��r�z��r o�r�/t /��G/ <br /> F. ACTION TAKEN <br /> f��"-7'��<,�'lin��iU!l _ pilo✓� ��i� �� � �✓��P� ,'fit c��;��«� <br /> din f1?� ex��/L M,74� <br /> /PGiv 4i� <br /> EH 22 03 (Rev. 7/89) <br />