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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> Health & Safety Code 4 25180.1 <br /> A. EMERGENCY LEVEL: IO II III Health District Log I <br /> (Circle one) <br /> i <br /> B. SOURCE OF INFORMATION a Lo D n <br /> Original Source: 1'1��` � Telephone: <br /> Reporting Agency Name: j0cE, S, V^"K _ 3 >y— ''G3 <br /> Agency Contact: 13-0 4-N S ]' (\ /TTelephone: �b�-7 / <br /> Address: 1 , O 1 �oX -SQL` �/ G� �SZU <br /> 7D 6 d <br /> C. LOCATION AND DATE OF DISCHARGE „µ , <br /> Date(s): 1 a -7 Time: Vtjr,Jd W /) <br /> Location: 02, OV F / �� v <br /> Best Physical Descr ton (City orunty <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: Q C4 <br /> Contact Person: gpc--r LAP— Telephone: <br /> Physical Address: <br /> I <br /> E. DESCRIPTION <br /> Type Release: DIAA� 6L iY/ 0 F Z--OP <br /> Volume; I (� — 1 ��1����'1� 0 /J CXkoM ,SJ �1 / <br /> Chemicals: Pg�-`T(Lo <br /> I <br /> i <br /> F. ACTION TAKEN <br /> G� nQ/t/ CAn C JC 4v A 1 (NV\ <br />