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SAN JOAQUIN COUNTYA <br /> NOTIFIOnON OF HAZARDOUS WAS ISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVE9'- T,\Ii III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: Telephone: (Ze <br /> Reporting Agency Name: div JMazt, &44t P1,411c, &A 2m;rns :Cermnek <br /> Agency Contact: L(I 5Telephone: <br /> - <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> jn�4w7le7 -.- h,.,,4- <br /> Location: 7-7 <br /> (Belt- i sic, esdiption) (City or County) <br /> Date of Discharge: - 44#­� <br /> Date Notified: 15 <br /> Time.. <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business _2wrbf- '141=2 <br /> Contact Person: i 3k^j 'ZW*j Telephone: <br /> Physical Address: <br /> E. DESCRIPTION <br /> 7}pe Release: 126 S=j &?k-6,z /M-3X,L92-2F, L828 39- <br /> Volume: <br /> IS7721g, <br /> Chemicals:A-?0�fWn S <br /> F. ACTION TAKEN <br /> A <br /> r,0 Lao <br /> EH 22 013 (Rev. 02/90) <br />