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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: II III <br /> (Circle One) HEALTH DISTRICT LOG <br /> B. SOURCE OF INFORMATION <br /> Original Source: j1A <br /> Telephone: (2 )���,- 3 I <br /> Reporting Agency Name: <br /> Agency Contact: <br /> � � � —'-'— Telephone. {?{Qj <br /> Address. k <br /> V E' f 205 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 12-5Dt, <br /> (Best Physical Descr3. tion) ✓ � <br /> p {City pr County) <br /> Date of Discharge: PQ C <br /> Date Notified: <br /> Time; - <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business <br /> Contact Person: prT:C- <br /> �C t� Telephone: (913) 3-SBP <br /> Physical Address : d$D <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: U <br /> Chemicals : Of fl A � <br /> S <br /> F. ACTION TAKEN : <br /> ` Q f�SbJ c-cJ eT-� � �,Tf1�t-'Ileo rtT�.�J l�t j.� -ru 6vJ tJ��S 2cm 1.t�T ,lam-ej�cRc�� <br /> r F <br /> �0`Ca�►�+k,`Za,.y k5 31�1� wlAttE. 1`ZCP� t1[r-- <br /> �-tQ.0 <br /> k <br />