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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 HEALTH DISTRICT LOG $ <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: �� rff5 Gini/ Telephone: <br /> Reporting Agency Name: 3,?v ✓04ra / <br /> Agency Contact: c.,�Nc , <br /> —_ATelephone : (' ) <br /> Address : / , . I [4n?,'14, 1/1 » p � aak 2ry� S(kNCA (�C20 ) <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: g20 S AmPr(��N �a <br /> ( Best_ Ph,•si. <br /> s (�-�Ly ui County ) <br /> Date of Discharge: ( o ktonc" <br /> Date Naotified: �/� +/� Time: <br /> `1: °%o PN <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business <br /> I II <br /> Contact Person: �ArYc,� 1P,Ol�c�1 Telephone: (,M) g _2 S� <br /> Physical Address : $20 S AHr�PrfCan) <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: N wN { <br /> Chemicals : <br /> F. ACTION TAKEN 0 <br /> �J <br /> & <br /> /tycrlcr/or� � PNCy <br />