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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A- EMERGENCY LEVEL: I II III <br /> (Circle One) HEALTH DISTRICT LOG p <br /> U <br /> B• SOURCE OF INFORMATION <br /> Original Source: —.Ho6 �C�C� I <br /> —�----'-� Telephone: <br /> Reporting Agency Name: — <br /> Agency Contact: <br /> �r�rrC r7l 17 Telephone: (2b <br /> Address: 5) y6 <br /> /1>zU/ .Elm —� c, 4, <br /> C- <br /> C• LOCATION AND DATE OF DISCHARGE <br /> Location: 6777 !/. �M Q <br /> Best Physical Description) <br /> Date of U <br /> Discharge; (C1tY o County) <br /> nKnowr( <br /> Date Notified: /D /:7-p pO?' <br /> ( Time: — 9' /.j <br /> D- RESPOIJSIBLE PERSON/BUSINESS <br /> Name of Business <br /> Contact Person: 18 <br /> Tele(4hone: (_) <br /> Physical Address: <br /> E- DL•'SCI2IPTION <br /> 'I'ypc Release: <br /> Volume: <br /> Clicnircals: P��TO IP U✓1/( �' b <br /> V n r- <br /> t'- ACTIQN T <br /> AKEN / <br /> �'E �JLQCGc° i � !C c_GULncC-rC 4- <br /> coo Py <br />