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V <br /> it <br /> J <br /> SAN JOAQUIN COUNTY!''. I <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH I SAFETY CODE 21151$0 .7 <br /> 4. <br /> A. EMERGENCY LEVEL: I II III HEALTH DISTRICT -LOG <br /> (Circle One) D <br /> B. SOURCE OF INFORMATION <br /> ./ � _ fTelephone: <br /> Original Source: �4�1 ZSct-- - <br /> Reporting Agency Name: _5 �.- �t ;.� �c' � ��rr�r�, ti��f,T .cr` <br /> Agency Contact: s ";Telephone: (?ac } -t!c9 ~3 37. <br /> Address : Ir c <br /> I[ C. LOCATION AND DATE OF DISCHARGE <br /> Location: <br /> (Best Physical -Descriptions) (City or 'County) <br /> Date of Discharge: } <br /> Date Notified: I1 / Time: <br /> D . RESPONSIBLE PERSON/BUSINESS <br /> Name of Business <br /> Contact Person: InHN . 7_, 5 _ _ Telephone; <br /> 4 Physical Address : <br /> E. DESCRIPTION y <br /> +t l I �rJ <br /> Type Release: � /--. ) .i,' <br /> Volume : C <br /> Chemicals : <br /> F . ACTION TAKEN <br /> ik7w <br />