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SAN JOAQUIN COUNTY O <br /> r NOTIFICATION OF HAZARDOUS WASTE DISCHA ' <br /> HEALTH & SAFETY CODE 25180 .7 <br /> C <br /> A. EMERGENCY LEVEL: I II III HEALTH DISTRICT LOG # U o 'OOs <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: 0 S _ Telephone: <br /> Reporting Agency Name: <br /> Agency Contact: Telephone: <br /> Address: <br /> S7/ <br /> F <br /> 1ple,41,1x7, 71l <br /> C. LOCATION, PND AATFi OF DISCHARGE <br /> %V M i , e'c cr�'Y U�iiTS o�✓ <br /> Location: /1/S f3itvo�S/DtE ` / - ^' 'T< �` <br /> (Best Physical scription) (City or County) <br /> Date of Discharge: <br /> Date Notified: //C���/� Time: . <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business <br /> Contact Person: bl/yetz2a - Telephone: ( ) <br /> Physical Address : <br /> E. DESCRIPTION <br /> Type Release: p?—SS 41id A15 <br /> �iT�z Gis�d r r ti r�oG� sfa.e� G✓a- �" <br /> volume : y�✓.�rio�.��� <br /> Chemicals : <br /> F . ACTION TAKEN �N72y <br /> A7 / <br /> f}-i`�n ,�/> i L1/es�- O� 61t�•C'�LS /��If-�iG/}7✓ �//�•y.�r`nrr <br />