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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 # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: <br /> Reporting Agency Name: �Jy�%Or�IIrG!!i✓ LocifL / ,/aLT ff ,/S�/'lG <br /> Agency Contact: Znl _�yel _ Telephone: <br /> Address: �, D, �Di� 21�01, 529CeC 0/✓, « ejf2.01 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 02��5��� / 2yi/i`�/t-�/%✓ / v ��� �/ ��L <br /> (Best Physical e� scription) (City or County) <br /> Date of Discharge: � 160I1Pl+/A-i <br /> Date Notified: /-- v/ �" � Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business e ,SVR,0/v ��27�LrivcoL.v UAL e �✓p <br /> Contact Person: <br /> --R , A , 6 6 FFA Telephone: <br /> Physical Address: v2�B.S /go",1 ,,ii✓�o�/LT ���1�7UN G� �,�"ZCji7 <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: U/t/;Cll owe✓ <br /> Chemicals : U�/rrlG Gpj,/T�M%��4Ti0� �rdsyr Ute/ eek H t� <br /> F. ACTION TAKEN <br /> G>e n�eu pteQ' �o <br /> {e►�w� h P. �L« l�►Gc--�-1 r�i 0- vLd <br /> Q S re bv 4-tt-- a ro !t c-/e eti c <br />