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r.d � <br /> SAN JOAgU1 N COUNTY <br /> NOTIFICATION UP HAZARDOUS WASE DISCHARGE <br /> HIALTH & SAFETY CODE 1518U .7 <br /> A. EMERGENCY LEVEL: � II III HEALTH DISTRICT LOG 9 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: �/i)rJ� 9a 'h0')-tS Telephone: <br /> Reporting Agency Name: AACc11r� �dCG /�r`��1 �Sfi`rr_f <br /> Agency Contact: j..lil f_ �Ljj&w Telephone : { ��rti ) � 7(Z 2c) <br /> Address • /60/ <br /> C. <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: <br /> . (Hest Physical Description) (City or County) <br /> Date of Discharge: <br /> ~ Date Notified: 3I12�L Time: <br /> D. RESPONSIBLE PERSON/BUSINESS } <br /> Name of Business 'C -,. �2z��J <br /> Contact Person: Telephone: <br /> Physical Address : /��/� �� Q <br /> E. DESCRIPTION 141- CHIP <br /> Type Release: <br /> Volume: <br /> Chemicals: <br /> F. ACTION TAKEN r <br /> r <br />