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F <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> Health & Safety Code § 25180.7 <br /> A. EMERGENCY LEVEL ,II III . Health District Log # - 00/2— <br /> (Circle one}- <br /> B. SOURCE OF INFORMATION Uh-S 77 <br /> Original Source: Telephone: { ) <br /> 11,, <br /> Reporting Agency Name: �h a. alia <br /> L. c_a_ _ _t I; <br /> Agency Contact: (.c Telephone: <br /> Address: 96' . . <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Date(s): -- + Time: <br /> Location: _ <br /> Best Rhys ca De r ption (City or C my <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: X cr—a <br /> Contact Person: a Telephone: { } -/:Z�{C� <br /> Physical Address: `�� , <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: <br /> r <br /> Chemicals: <br /> F. ACTION TAKEN <br /> I <br />