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SAN JOAQUIN COUNTY Q <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180 .7 <br /> A. EMERGENCY LEVEL: I II IIZ <br /> HEALTH DISTRICT LOG <br /> (Circle One) <br /> B. SOURCE OF INFORMATION,,,99 <br /> Original Source: x`D�iJ ,/I�ID�/�/�, Telephone: Qzz ) <br /> Reporting Agency Name: U C /S /f7: <br /> Agency Contact: /�l�X�/1//�_ Telephone: ( ) `3 <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: /V' �/� <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: ' 2,u - <br /> Date Notified: 6 16 / Time: -OCA <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business <br /> Contact Person: Telephone: <br /> Physical Address: <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: <br /> Chemicals: <br /> F. ACTION TAKEN <br /> 1i( 9= u l s 5Ul <br /> r�1 <br />