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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGL: <br /> HEALTH & SAFETY CODE 25180 . 7 <br /> A. EMERGENCY LEVEL: lI II III <br /> (Circle <br /> HEALTH DISTRICT LOG 8 <br /> One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: ` W101 r✓i�t Telephone: <br /> Reporting Agency Name: /5����T <br /> Agency Contact: l%/9j/y/l% ,� (� Telephone: (2�; ) .35C j <br /> Address : ? a. fir ,`i <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: /., /a 114,yOov LT <br /> (Best Physical Description) (City Or County) <br /> Date of Discharge: <br /> Date Notified: o? Time: _ raj f.- <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business 1�(Jdd/jr1�w .�!.�� ,or�s <br /> Contact Person: �j j2L� y� Telephone: 3 -G?/(,j�" <br /> Physical Address : �aCjcJyv�� �j7 (rll �/lR/�F�l� <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: <br /> Chemicals : C✓,0�7F 611/ <br /> F. ACTION TAKEN <br /> wr✓tSTG od t z7- L&V <br /> �,Qi,�� �lE /�•1.�GSS H�Li T u/ild.d'E �C-I�,oit'CZl i� i o��.G� 711�- <br /> �c�i"� �rG�iL��siitii�iior/ ,rs E�Gldli B� 7rs� llrs�L .r? �r�,q-may <br /> L <br />