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SAN JOAQUIN COUNTY <br /> r^ NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> Health & Safety Code § 251.80.1 <br /> 22 <br /> A. EMERGENCY LEVEL- I II III Health District Log !` <br /> (Circle one) <br /> B. SOURCE OF INFORMATION - <br /> Original Source: Telephone: <br /> Reporting Agency Name: 2L= <br /> t Agency Contact: Telephone: ) -� <br /> i=- <br /> Address: 42- 64 2 GO <br /> .• <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Date(s): A2- 7. -- Time: &Z <br /> Location: r <br /> tr County)s ca <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: . <br /> Contact Person: Telephone: (2:0-P 36 <br /> Physical Address: d2 z <br /> E. DESCRIPTION _- <br /> Type Release: <br /> Yo l tmie: <br /> Chemicals: <br /> F. ACTION AKEN <br />