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SAN JOAQUIN COUNTY <br />NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br />HEALTH & SAFETY CODE 25180.7 <br />A. <br />EMERGENCY LEVE PHS -EH LOG# WC/ <br />(Circle One) <br />B. <br />SOURCE OF INFORMATION <br />Original Source:_ Tr) I , ' <br />j n <br />I hone: <br />Reporting Agency Name: <br />Agency Contact: <br />Telephone: <br />Address: <br />C- <br />LOCATION AND DATE OF DISCHARGE <br />Location: <br />(Best Physical Description) <br />(City or County) <br />Date of Discharge: --I <br />Date Notified: <br />Time: <br />D. <br />RESPONSIBLE PERSON/BUSINESS <br />Name of Business 4, <br />Contact Person: <br />Telephone: L <br />Physical Address: <br />E. <br />DESCRIPTION <br />Type Release: it <br />Volume: <br />Chemicals: <br />F. <br />ACTION TAKEN <br />1 r <br />H 22 03 (Rev. 7/89) <br />