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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> .. HEALTH & SAFETY CODE 25180 . 7 <br /> COPY <br /> A. EMERGENCY LEVEL: I II III HEALTH DISTRICT LOG <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: � T�mC FAdi�s4 Telephone: (�) L/�j�-,yyy0 <br /> Reporting Agency Name: "f1QK/ ibis/2�Ci <br /> Agency Contact: _ /'qj�� f�(W Telephone: ( ') <br /> Address: ,Q D 0-�z -�ndc/ Sfdd�Cl�n 952 / <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: ad , / J <br /> (Best Physical Description) (City or Country ) <br /> Date of Discharge: 60-klxe�k� <br /> Date Notified: L-/? � �j Time:II <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Businessp �/Ui�PcO Sed <br /> Contact Person: c� Qr(E¢/1� Telephone: <br /> Physical Address: �z <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: <br /> Chemicals: 017le,c ckcQ <br /> F. ACTION TAKEN <br /> �/v 17'wlylvlh, <br /> � 0 0 <br />