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1 <br />} <br />SAN JOAQUIN COUNTY O <br />NOTIFICATION OF HAZARDOUS WAS <br />HEALTH & SAFETY CODE 251 8 U I� CIIIIRGE O <br />A• EMERGENCY LEVEL: III III <br />(Circle One) (..- <br />B. <br />IIEALTH DIS`1'RICT LOG <br />SOURCE OF INFORMATION <br />Original Source: _ f�.f,.��,� , <br />Telephone: <br />Reporting Agency Name: �� 1 <br />Agency Contact: <br />Address: Telephone: <br />fS 3y� c <br />C• LOCATION AND DATE OF DISCHARGE <br />Location: <br />(Best Physical Description) / <br />Date of Discharge: -�_<� <br />Date Notified: <br />D. RESPONSIBLE PERSON/BUSINESS Time: <br />E. <br />F. <br />Name of Business 1,A] -I <br />( City or County)� <br />Contact Person:..���� <br />Telephone: <br />Physical Address:) <br />DESCRIPTION <br />Type Release: <br />Volume: <br />Chemicals: <br />— �; 'L <br />ACTION TAKEN <br />77 <br />