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8 <br /> SAN JOAQUIN COUNTY <br /> �� <br /> NOTIFI,�TION OF HAZARDOUS WAST�,JISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG # q l 17 <br /> (Circle One) <br /> B. SOURCE OF INFORMATIONoz- <br /> Original Source: Telephone: (dog, ) V(W -3y(O d" <br /> Reporting Agency Name: lsol ✓ices <br /> Agency Contact: Telephone: al <br /> Address: IF <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: - <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: <br /> Date Notified: /-ig'-si Time: //A,22 <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business7111 <br /> Contact Person: 9,,,j« Telephone: (a6q ) <br /> Physical Address:E. DESCRIPTION <br /> Type Release: <ri crest 1z; za�� <br /> Volume: <br /> Chemicals: <br /> F. ACTION TAKEN <br /> crn�e r l�i7Tyr� Corr �n1��a�iLj tr s I t1/,_ d✓ 7�i�� y�2 u/;1 <br /> 7 <br /> EH 22 013 (Rev. 02/90) <br />