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SAN JOAQUIN COUNTY ' O <br /> NOTIFICATION OF I-iAZgRDOUS WASTE DISCHARGE <br /> "EALTI-I & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:O II III C�(� <br /> (Circle One) PHS-EH LOG # <br /> B. SOURCE OF INFORMATION <br /> Original Source: S�. <br /> u � Telephone: <br /> Reporting Agency Name: (0, 7 a S — 7 A h; <br /> Agency Contact: <br /> 7 <br /> Telephone: "_.L1 <br /> Address: � a o 0 9 <br /> C- LOCATION AND DATE OF DISCHARGE <br /> Location: �'�� y <br /> (Best Physical Description) / <br /> (City or County) <br /> � <br /> Date of Discharge: oZ <br /> Date Notified: <br /> D• RESPONSIBLE FERSON U Time: —/-60 <br /> SINESS <br /> Name of Business <br /> Contact Person: ,D, R41, <br /> • <br /> y "%l Telephone: 15 7� —1 I <br /> Physical Address: . O V4 <br /> '� tf <br /> E. ,DESCRIPTION <br /> Type Release: <br /> Volume: - /21!! <br /> Chemicals: <br /> F. ACTION TAKEN <br /> k3 <br /> • Ltl S <br /> EH 22 03 (Rev. 7/89)' � •�—� � <br />