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I <br /> SAN JOAQUIN COUNTY A. <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE C 0 py <br /> HEALTH & SAFETY CODE 25180.7 , <br /> A. EMERGENCY LEVEL: II III HEALTH DISTRICT LOG # <br /> (Circle One) -©� <br /> B. SOURCE OF INFORMATION <br /> OriginalSource: <br /> Telephone: S,�,6 3 <br /> Reporting Agency Name: <br /> oa iia. L ac-�� 1-f e•.���....Q�S�v��t <br /> Agency Contact: DaYtid (� �,ts .Telephone: (Zn-1) 46& ~3[fe(p <br /> P <br /> Address: lbp i <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 3 40 <br /> VaC <br /> (Best -Physical Descriptidn) (.City-or ounty) <br /> Date of Discharge: 3r�,71(-S <br /> Date Notified• 5 �/!47- <br /> Time: vh hd�w <br /> D. RESPONSIBLt PERSON/BUSINESS <br /> Name of Business r ve. <br /> Contact Person: 5er,, Sig. c14.',r <br /> Telephor�,e: <br /> Physical Address : <br /> E. DESCRIPTION <br /> 5 <br /> Type Release : <br /> Volume: <br /> Chemicals <br /> F. ACTION TAKEN <br /> moo;( Con ti a wtna`� ro r� ] a►^ l c Cis 1� aY�oJc��� <br /> i ( <br /> PCO <br />