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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180 . 7 <br /> A. EMERGENCY LEVEL: ?I II ITI HEALTH DISTRICT LOG # y <br /> (Circle one) f <br /> B. SOURCE OF INFORMATION <br /> Original Source: Telephone: <br /> Reporting Agency Name: Li <br /> Agency Contact: Will LL•,q JN VEL Telephone: <br /> Address : 0 . (3v 2-00 �' 0 Clle7b/L/ CA- q!5 Zv r <br /> C. LOCATION AND DATE O'F DISCHARGE <br /> Location <br /> - la�l7d�.i <br /> Date of Discharge: U <br /> Date Notified: —Rei Time: , aG iti <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business 60('/)I <br /> Contact Person: [. ' <br /> vl Telephone: ( ) <br /> Physical Address : <br /> E. DESCRIPTION <br /> Type Release: 01 / zed l ar_ Ee. <br /> Volume*_ 6it//�"Jdv/V <br /> Chemicals: ' — Ala f `z <br /> F. ACTIO] TAKEN �G7lO �/i✓G��'r�y-�i �+..a r�I S�D/`G�J!�' T/fi'✓�S f'�'fr�U s/'�,G�. <br /> 5�Z1 e ;�<< 6��' •e <br /> ^/ e, <br /> C(OPY <br />