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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II III HEAL'E'R`` DISTRICT LOG <br /> (Circle C <br /> B. SOURCE OF INFORMATION <br /> Original Source _f� � � <br /> Reporting ASI r ,� ", <br /> Agency CoM=i;;!! <br /> 1 + <br /> Address: <br /> C. LOCATION AND DATE'OF DISCHARGE <br /> Location ' <br /> R Ri I City 'or County <br /> Date of Discharge: <br /> Date Notified: Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business , <br /> Contact Person: InYLL2,70 <br /> Physical Address: �6-3,04� <br /> E. DESCRIPTION <br /> Type Ra <br /> Volume: <br /> Chemicals: <br /> F. ACTION TAKE <br /> " I ,tt rr, 1 <br /> 441 <br /> copy`' <br />