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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> f� HEALTH & SAFETY CODE 25180 .7 <br /> A. EMERGENCY LEVEL: III HEALTH DISTRICT LOG <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: ^i�lp/1! � 1�`� ��c� Telephone: Po-'I) <br /> Reporting Agency Name: f <br /> Agency Contact: LGly42 Telephone: <br /> Address : Zal <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: /). �jI., he,(— / <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: <br /> Date Notified: //�/$/� Time: r_/,�rJ&-- <br /> d <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business <br /> Contact Person: _ ����,f7v Telephone: <br /> Physical Address: o20/ C"q 9�/Cr- <br /> E. DESCRIPTION <br /> Type Release: 9;1; I6) A,; - <br /> Volume: <br /> Chemicals: <br /> F. ACTION TAKEN <br />