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SAN J OAQU I N COUN'T'Y <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE 19 �� <br /> HEALTH & SAFETY CODE 25180 .7 1 � I <br /> - i <br /> A. EMERGENCY LEVEL: II III HEALTH DISTRICT LOG <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: Telephone: ( 4rl_-3- -7/ <br /> Reporting Agency Name- <br /> Agency Contact: Telephone: <br /> Address: DO 9 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: / J <br /> (Best P ysical Des ription) {City drl ounty} <br /> Date of Discharge: <br /> Date Notified: Z2 - /Q - Time: /•'CJa �,��j , <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business S <br /> Contact Person: Telephone: <br />.t Physical Address: l <br /> E. DESCRIPTION <br /> Type Release: —_ r <br /> Volume : f <br /> ( 1 <br /> Chemicals : <br /> F. ACTION TAKEN <br /> S <br /> I Of <br />