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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: 6) II III HEALTH DISTRICT LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION '' <br /> Original Source: �/ DA/ �igSO/✓ Telephone: (2 9 ) <br /> Reporting Agency Name: . 5q 1 jy/�Q L,,L z*V Aw?w <br /> Agency Contact: /), /,v� P/Yi�r— Telephone: <br /> Address: /K-0L <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: ,301 e. //,o9cY <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: ,/ 1g j- <br /> Date Notified: 4z Y22 Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business <br /> , <br /> Contact Person: /j�Jyt/ %%/ �dzJ Telephone: ) X35-97//r- <br /> Physical Address: &p ee-. <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: <br /> Chemicals: ✓7ieS�� <br /> F. ACTION TAKEN <br /> p � s/� o�P�.�.� f <br /> ct � <br /> or el <br /> / ✓ o <br /> �G�✓G �iY�iY/ �/�//y/ i1 Adm F' �,�/ <br />