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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH S SAFETY CODE 25180 . 7 <br /> 1 <br /> A. EMERGENCY LEVEL: ! I / II III HEALTH DISTRICT LOG a <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: l ancni.Q" �n0ji2y n Telephone: '1(_-bCI) <br /> Reporting Agency Name: <br /> Agency Contact: �Rmrk P4A I0, Telephone: ( !2 ) <br /> Address : <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: <br /> (Best Physical� Desc ption) (City or County) <br /> Date of Discharge: <br /> Date Notified: -33-fig Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business <br /> Contact Person: ��Telephone: (_) -.) 5 <br /> Physical Address : --311 �)Le <br /> E. DESCRIPTION <br /> Type Release; <br /> Volume: M�LYlJ141 �_ <br /> Chemicals : <br /> F. ACTION TAKEN <br /> �rxfw ( � �e aS cviJc> �i �Q /Yvw <br /> ✓l'CtPMM'C (1 Pl)(�Q�� 0 t ( (�Yl t3 m Irl C4 <br /> r <br /> v <br />