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T, <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> Health & Safety Code 4 25180.7 <br /> A. EMERGENCY LEVELC, II III Health District Log # -0011-/,-2 <br /> (Circle one) <br /> B. SOURCE OF INFORMATION <br /> Original Source: Telephone: ) <br /> i <br /> Reporting Agency Name: <br /> Agency Contact: Telephone: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Date(s): Time: ' UjV,� <br /> Location: / <br /> Best P sica scription ty or Coutity <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: <br /> Contact Person: Telephone: <br /> Physical Addres <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: <br /> Chemicals: <br /> F. ACTION TAKEN <br />