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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25160 . 7 <br /> A. EMERGENCY LEVEL: I II III <br /> (Circle One) HEALTH DISTRICT LOG # ✓' � ,�7 <br /> B. SOURCE OF INFORMATION <br /> Original Source: % r F V/z"� <br /> Telephone: <br /> Reporting Agency Name: L,qX-) \Zn <br /> r?(.uiv /Cn;t/' 7��Ltt/ �iS%C'iCT <br /> Agency Contact: � <br /> Telephone: (.,LF/ ) <br /> Address: &,/ c2M� <br /> � S71IC'/'y7,v n.a %` 711 / <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: _Ld_! eU <br /> (Best Physical Desc i tion) <br /> p (City or County) <br /> Date of Discharge: UA kmfro-� <br /> Date Notified: /p�c���� <br /> Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business _W� SiOrl/� <br /> oD PTS <br /> Contact Person: .Tack S�/e107l177 Telephone: _ <br /> Physical Address : _ 16 as <br /> 3 <br /> E. DESCRIPTION <br /> Type Release: PC <br /> Volume: 7J7�n�) <br /> Chemicals. ' <br /> F. ACTION TAKEN 61 <br /> �"�2 �� Ao� i� _P e2' �nm ✓�' <br /> �il/ C'k �ncft�� ao <br /> � Sulu C ca,� •mac r �. �' ,tt G <br />