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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 HEALTH DISTRICT LOG N <br />(Circle One) <br />B. SOURCE OF INFORMATION <br />Original Source: �, %,&E w,(�/j— Telephone: (,�Fl <br />Reporting Agency Name: TfA_l�%D/iCrJlJia/ ZLq/f/ ,tG,2ZII-a ,/5i���� <br />Agency Contact:c%rfi//!�/ ft�/i« Telephone: (_) <br />Address: PO --3 ?k- ,2007 k) Cil 5;5 2U/ <br />C. LOCATION AND DATE OF DISCHARGE <br />Location: /7p� �, Alez-&t /�?L--) / �SCCj/l <br />(Best Physic Description) (City or County) <br />Date of Discharge: /jt�A)Dcci� <br />Date Notified: /—moi f`% Time: <br />D. RESPONSIBLE PERSON/BUSINESS <br />Name of Business 2-y,,�Zj <br />Contact Person: (VIA /eLllC Telephone: <br />Physical Address: /? p�' Z17 <br />iir�- <br />E. DESCRIPTION <br />Type Release: L4 6 <br />Volume: <br />Chemicals: <br />F. ACTION TAKEN <br />L.r <br />7 <br />