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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180 . 7 <br /> A. EMERGENCY LEVEL: lI II III HEALTH DISTRICT LOG # <br /> ( Circle One ) <br /> B. SOURCE OF INFORMATION �/ �} <br /> Original Source: UU/Y�G 7 1?'CMlev phone: <br /> Reporting Agency ,Name: �AW e--A( ±fNZd <br /> Agency Contact: 11f%I�M"^c A( -01 /Telephone: (� <br /> Address : 1L� In � �UN cA Ste/ <br /> C. LOCATION AND DATE OF DISCHARGE/ <br /> Location: oc f �A4Q <br /> (Best Physicai Desc ption) (City or County) <br /> Date of Discharge: )1A)t1J <br /> moL p� <br /> Date Notified: JJ Time: 7i0C�/y!✓, <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business 7ml NCO2�� <br /> Contact Person: �'_ W (.A �S Telephone: (J? 3 1— <br /> ,`CAT �A <br /> Physical Address : Vy (/Q S71oy � <br /> E. DESCRIPTION — _� <br /> Type Release: l )& (.�1A�on Geri re feA,5e <br /> Volume: M LjgO W A[ 1 <br /> Chemicals : �a-��t, � � V �� e � � }-4 �iO(MCO 'bOAs , -Z7.4/ 0/ � <br /> F. ACTION TAKEN <br /> �i�e (issPsshiehf �.� l�ro� rea w�r� <br /> Gerdia / y4z/Le4a 'on a11 ?4rnrA' . lee&zj.-cA / Al2/tle, <br />