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7 <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE y <br /> HEALTH & SAFETY CODE 25180.7 0 PDY <br />_ A. EMERGENCY LEVEL: <br /> (Circle One) II III HEALTH DISTRICT LOG <br /> B• SOURCE OF INFORMATION <br /> Original tSource: ��,GIa; T,� � ; <br /> Telephone: ( 2+n,? <br /> Reporting Agency Name: <br /> Agency Contact: 0A�;d fls <br /> e Telephone.- <br /> Address: f6d r . E - <br /> C.;,�- <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: . <br /> (Best ..Physical Description) / y <br /> / (•1-1-;Ir-y-- o <br /> or 'County)- <br /> Date of Discharge: <br /> Date Notified: . <br /> 5f/14 <br /> Time: <br /> D. RESPONSIBLt PERSON/BUSINESS <br /> Name of Business <br /> V`vc�Ctiv. <br /> Contact Person: �evv S;� �I�,,r <br /> Telephoge: <br /> Physical Address • 3 <br /> E. DESCRIPTION <br /> 5 <br /> Type Release: 4L- S � <br /> Volume : <br /> Chemicals : 1 l k <br /> F. ACTION TAKEN r y J <br /> moo;� Cay�.o.�h��c�-rb r� �'�C �►� L�C>-S ]^ T�v1w Jc�-(. <br /> �v✓ tl.Qv $ A SS esswe <br /> C. e✓'..n.,rt <br /> ,.. IAA,r QvO✓, <br /> Ira <br /> 1 <br />