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F <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE25180 .7 <br /> A. EMERGENCY LEVEL: II III <br /> (Circle One) HEALTH DISTRICT LOG <br /> :. Q r I <br /> , <br /> B. SOURCE OF INFORMATION <br /> Original Source: Telephone: (kJ7 <br /> Reporting Agency Name: d • S <br /> Agency Contact: -/0-4217-- Telephone: <br /> Address: / Q/ _ E% a .J...Ave <br /> C. LOCATION AND ;DATE OF DISCHARGE <br /> Location: _ C�� <br /> (Best . Physical °Description) (City or County) <br /> Date of Discharge: & g <br /> Date Notified: ! . Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business �� r r yiyi/ %t .. <br /> Contact Person: Telephone: ) <br /> Physical Address: 3U Y <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: a �, <br /> I, Chemicals: IZD/if <br /> F. ACTION TAKEN <br /> s - in <br />