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C(apl <br /> SAN JOAQUIN COUNTY • <br /> NOTIFICATION OF HAZARDOUS WASTE 61ScHARGE 4 <br /> HEALTH & SAFETY CODE 25180.7 ' <br /> A. EMERGENCY LEVEL: I II III <br /> (Circle One) HEALTH DISTRICT LOG # Q-16 <br /> B. SOURCE OF INFORMATION <br /> Original Source: yt�(//lI a e+�5 % ., Telephone: <br /> Reporting Agency Name; <br /> Agency Contact: G- 4' 0'� �"Y/zTelephbne: <br /> Address: 0IJr <br /> oes c,�1¢irI <br /> C. LOCATION AND ,DATE OF DISCHARGE <br /> Location: <br /> fl3est P ysical cr ti ! -----� <br /> p on) (City or County) <br /> Date of Discharge: <br /> Date Notified: �' 2 _ , <br /> Time. <br /> D. RESPONSIBLE "PERSON/BUSINESS <br /> Name of Business <br /> 1 � ems <br /> Contact Person: ®-7 ,�,�,,,�•�,. Telephone: <br /> Physical Address: h . <br /> E. DESCRIPTION <br /> Type Release: �r�sf G? <br /> Volume: <br /> Chemicals " h e <br /> . F <br /> F. ACTION TAKEN <br /> .44rs <br /> U �• r <br /> tom_i <br />