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SAN JOAQUIN COUNT 0� <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHA <br /> HEALTH & SAFETY CODE 25180 . 7 <br /> A. EMERGENCY LEVEL: I II III <br /> (Circle One) HEALTH DISTRICT LOG # I5b <br /> B. ; SOURCE OF INFORMATION <br /> *t <br /> Original Source: <br /> telephone: (2221) &Clo <br /> Reporting Agency Name: l � <br /> Agency Contact: <br /> Telephone: <br /> .. Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 1/7 �/ -� �^ ��' <br /> (Best Physical Description) �r�� <br /> (City or County) <br /> Date of Discharge; �._�R9 <br /> Date Notified: <br /> Time: <br /> D. RESPONSIBLE PERSON/BUSINESS - — <br /> Name of Business j�1/may <br /> Contact Person: <br /> r Telephone: <br /> Physical Address; `/OD ��, ✓ i <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: <br /> Chemicals . / <br /> F. ACnnTION TAKEN / 1 <br /> �QrL /9t /tlrf/ <br /> ,-16 2 <br /> -r�irley, <br /> (4) <br /> a <br />