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SAN JOAQUIN COUNTY <br /> NOTIFICkwiON OF HAZARDOUS WASTE bV6CHARGE . <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: 0 II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: _ ��o a(&lf-049-M WIVtp2T Telephone: Zoe ) 5r1�- 7-(r ) <br /> Reporting Agency Name: �.-Sa stn Ce.�l hlt� Ne��t� viCes �n�v. Deaf tv�SroaJ <br /> Agency Contact: aw-v) Telephone: (,�o ) q 61,_— 3 qq J <br /> Address: N S'aw �da ui►n �.0.1�oX Zoo oC��on� S i a -1�ok} <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 0 0 0 w I z0 to I) <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: V'r k--Y Ow o <br /> Date Notified: Time: <br /> —�r- <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business rt a. --�brO q,,-_V-5w*(vt e f <br /> Contact Person: -TmV15 Telephone: (?oTT <br /> Physical Address: Gq 9 _3 L <br /> E. DESCRIPTION <br /> Type Release: UAQ <br /> Volume: UV\. to 0 <br /> Chemicals: d n <br /> F. ACTION TAKEN <br /> a_ t -t o c� c 9w b2 o <br /> 6JL &V <br /> tnA <br /> EH 22 013 (Rev. 02/90) <br />