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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180 .7 <br /> A. EMERGENCY LEVEL: CI) II III HEALTH .DISTRICT LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: DO— V, Telephone: (zog qray -f3'4 <br /> Reporting Agency Name• <br /> Agency Contact: ba,Id Telephone: 3vcfl <br /> ..Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: <br /> (Best Physical Description) .- (City or County) <br /> Date of Discharge: 3' 1 Fs is 7- <br /> Date Notified: /67 Time: <br /> D. RESPONSIBLE PERSON/BUSINESS . <br /> Name of Business ��e� Co-s4, vee-'ate <br /> Contact Person: Do,, K��� <br /> Telephone: (2u5. )u6 q.gjyc( <br /> Physical Address : <br /> E. DESCRIPTION <br /> Type .Release: v ev <br /> Volume: <br /> Chemicals- <br /> F. ACTION TAKEN (� <br /> a J <br /> VL <br /> 1�`L.- J c e1F� SO../`C�S 1Ccl <br />