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f� <br /> Jj SAN JOAQUIN COUNTY <br /> NQTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL I <br /> II <br /> (Circle One) III PHS-EH LOG # (� <br /> o�S <br /> B• SOURCE OF� INFORMAT S <br /> IONY <br /> Origi.Qal Source: <br /> Reporting Agency Nie; - Telephone: (��ej8'-7 4(� <br /> Agency Contact: <br /> :Address: ` Telephone: <br /> C. ' LOCATION AND DATE OF DISC U <br /> ,'Location: <br /> (}3est Physical Descri t'ionf <br /> p ) <br /> Date of-Discharge: (City or County) <br /> Date Notified: <br /> Time: a :D Q <br /> D. RESPONSIBLE P <br /> ON/BUSINESS <br /> Name of Business G� <br /> Contact Person: <br /> ell <br /> Telephone: 7 �� � "� <br /> Physical Address: a 4 <br /> E. DESCRITTION � <br /> T`YPe Release: <br /> Volume: I <br /> 6ernicals: <br /> F. A l l'1QN TAKE C <br /> ' �a <br /> A J <br /> EH 22 03 (Rev. 7/89) <br /> # _ v _ <br /> t <br /> ir. <br />