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y✓ SAN JOAQUIN COUNTY ,L" <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE === <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II O PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFO TION( Tele h ( ) -�(�- <br /> Original Source: I/1 phone: <br /> ou <br /> Reporting Agencyame. 1111 <br /> Agency Contact: elephone: (seq) 4(Qk3 -,545-7— <br /> Address: <br /> 3457Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 45 ZC) S. I- W q 9c) <br /> (Best Physical Description) (City or ount <br /> Date of Discharge: UA, A Al`' <br /> Date Notified: Time: o <br /> D. RESPONSIBLE PEWiln')BUSINESS C <br /> Name of Business <br /> Contact Person: sk'u-f- Telephone: ( 915) <br /> Physical Address: 10990 <br /> E. DESCRIPTION <br /> Type Release: M 1M <br /> Volume: <br /> Chemicals: <br /> F. ACTION TAKEN <br /> MA aL e,o MIA— <br /> ::fLA4 vy-p- wl <br /> v� <br /> EH 22 013 (Rev. 02/90) <br />