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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180 .7 <br /> A. EMERGENCY LEVEL: ( I J II III HEALTH DISTRICT LOGS -` <br /> (Circle One) <br /> B. SOURCE OF INFORMATION r f� <br /> Original Source: /'k�_ +' �� r_ Telephone: <br /> Reporting Agency Name: <br /> Agency Contact: j_/7(,(h ! , -; '' �' r Telephone: (22') <br /> Address . r fn.�' ( ��ti�, �_� � i �.( �� �.��Ci'^t C��C <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: fb3 E-- /�;T�( ��y - / <br /> (Best Physical Description) (City o)� County) <br /> Date of Discharge: 10b -lu <br /> Date Notified: fO�Z �'1 _ _ _ Time: 0 /J as•=— <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> 17 <br /> Name of Business 1.- 91..r ;,'� /7 r; i,? �fCe•� <br /> Telephone: <br /> Contact Person: �i ( [ p <br /> Physical Address : r <br /> E. DESCRIPTION <br /> Type Release: r <br /> (J G�`Y1�`rZvyrU <br /> Volume: L e <br /> Chemicals: <br /> F. ACTION TAKEN <br /> G' <br />