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i <br /> SAN JOAQUIN COUNTY Ge <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE•' <br /> HEALTH & SAFETY CODE 25180 . 7 <br /> A . EMERGENCY LEVEL : /L1 ) II III <br /> ( Circle One ) HEALTH DISTRICT LOG <br /> B . SOURCE OF INFORMATION <br /> Original Source : jCi /1 � •, i� , <br />:1 r l �n r i Telephone : (ZLi.1 ) Lll.q <br /> Reporting Agency Name : �j , Jr ( 4 , . � <br />§ Agency Contact : (_i) , rr , r . ,� Telephone : <br /> Address : � r <br /> C . LOCATION AND DATE OF DISCHARGE <br /> Location : (1d��� 1 r J" iF: ���nn1T( Best v :: ca Description ) / ( city , County ) <br /> Date of Discharge : g��j / { <br /> Date Notified : Time : <br /> Do RESPONSIBLE PERSON/BUSINESS —, <br /> Name of Businessesowot � <br /> Contact Person : l ��UC`�`_ 1.--./ C•rtJrrn h rr re1A <br /> E . DESCRIPTION <br /> Type Release : 1LJy� • ( S .' ,vr .l y / <br /> Volume : <br /> r , n1609/ , n = (aP111r1: <br /> Chemicals : <br /> `/ i71Fui?t —/ ) c. /� ll/i-li • ;%�7iY: � <br /> r <br /> F - ACTION TAKEN <br /> rczu <br /> F_ f"x)11 6'(=71 '77) /�F ri'r"> • I i 'r Y ' - <br /> � � lii a 11: x .✓ <br />