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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH 6 SAFETY CODE 25180. 7 <br /> A• EMERGENCY LEVEL: <br /> (Circle One) ` HEALTH DISTRICT LOG /� <br /> B. SOURCE OF INFORMATION <br /> Original Source: 1� <br /> r' ` Telephone: <br /> Reporting Agency Name: f <br /> Agency Contact: ( d, t , <br /> t ' r Telephone: <br /> Address: I(//; � <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: <br /> (Best Physical Descri tion) <br /> A (City O;: County) <br /> Date of Discharge: ZLIS <br /> r <br /> Date Notified: Time: ' <br /> D. RESPONSIBLE PERSON/BUSINESS !' <br /> Name of Business Yh/!( tr+U <br /> Contact Person: ��s7i[f R � Telephone: ( ) <br /> Physical Address: �;�, F%'E"ean <br /> E. DESCRIPTION <br /> Type Release: _��.:'y/;-r/�.'ri•nilSLzcar^. 7 ,E /r/n <br /> Volume: I niCr�i r )I ) `�;ifo6,r <br /> Chemicals : _ f ✓ <br /> I , <br /> F. ACTION TAKEN <br /> n ' <br /> �Y�lr_ lY: An-r �lATi4)n A r7/ ,^ "-rH - r�7- <br /> > ri.2r�4 -?) <br /> i <br /> 60 --- <br />