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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 I <br /> � I <br /> A. EMERGENCY LEVEL: d II III PHS-EH LOG # 2q o 7 <br /> (Circle One) I� <br /> B. SOURCE OF INFORMATION <br /> Original Source: o�/,%' (���7�vS' i°'s Telephone: c(//� 2-9 <br /> ©� <br /> Reporting Agency Name: 5�r <br /> Agency Contact: ����+�� s��` Telephone: <br /> Address: 4� <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: Le�z-/ <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: <br /> Date Notified: //- Z�' —� Time: <br /> ((w D. RESPONSIBLE PERSON/BUSINESS L <br /> Name ofBusiness a - <br /> Contact Person:o4C6 Telephone: <br /> Physical Address: <br /> � <br /> E. DESCRIPTION <br /> Type Release:Oc�/yfr �I c LvY�t Ickl ncufcs wit/ 1-4/'/C-o,46 <br /> V+oIR>aS� orrA��c✓� — �voc F- /Y�� y (/O�.•rv< << un�/YX.�YI. <br /> Chemicals:�� �''! c�a ��t <br /> F. ACTION TAKEN <br /> C <br /> f�✓/7fnA <br /> A-r�/ y Ar" )/ ?Va IUQctC <br /> /�/it✓ 1 51'ile <br /> ��t PX/l/l( s� l�i/Lc�i/Js/�<� os /PJB.tee.✓ 49 <br /> EH 22 03 (Rev. 7/89) <br />