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.w <br /> ii <br /> SAN JOAQUIN COUN'T'Y <br /> NOTIFICATION OF EIAZARDOUS WASTE DISCHARGE <br /> HEAL`i'11 & SArETY CODE 25180 .7 <br /> A. EMERGENCY LEVEL: II III H EALTI'1 DISTRICT LOG # n-7/3; <br /> (Circle One) . <br /> B. SOURCE OF INFORMATION <br /> Original Source: _ r"P S _ � � �� Telephone: (2o4) <br /> Reporting Agency Name: [� <br /> Agency Contact: Telephone: (D-Or�) <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE , <br /> Location: <br /> (Best Physical escrintion) (City or county ) <br /> Date 'of Discharge: <br /> IFIL. <br /> Dateiallotified: Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name ''of Business <br /> Contact Person: -2 Telephone: <br /> i <br /> Physical Address : <br /> E. DESCRIPTION <br /> Type °Release: <br /> r <br /> Volume: L1 <br /> Chemicals : <br /> F. ACTION TAKEN <br /> i <br /> ' I <br /> i <br /> i <br /> a <br />