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rip - <br /> SAN JOAQUIN COUNTY O <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARG <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: II II III HEALTH DISTRICT LOG # —( J <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: &-uw dm� � Telephone: <br /> Reporting Agency Name: S sS ��-Q� - <br /> Agency Contact: z� t,G 6 Telephone: (2,67) y68-3`/7 0 <br /> Address : PO' ZOO`S d4 qf 101 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 001 <br /> (Best V,ysical Description) (City or County) <br /> Date of Discharge: <br /> Date Notified: Time: 9` <br /> D. RESPONSIBLE PERSON/BUSINESSS <br /> Name of Business <br /> Contact Person: ! Telephone: (Jori) G}S 2 767b <br /> �UPhysical Address : y <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume : &1�,� <br /> Chemicals : 1d <br /> F. CTION TAKEN AM.4;h1, �� �G1 (➢l �c ��OY� tntx�( /�oLC GCC <br /> it-ca�L <br />