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SAN JOAQUIN COUNTY <br /> 1 NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180 .7 <br /> A. EMERGENCY LEVEL: ( I II III HEALTH DISTRICT LOG # O[J <br /> (Circle One) 1 <br /> B. SOURCE OF INFORMATION <br /> l �„ Esc /ate <br /> Original Source: Sr �Sp�/fs 5�✓i Tele hone- <br /> Reporting Agency Name:S"17 -T,0,4 .j4t,,l L&A4, <br /> Agency Contact: /J'//'�- SNAV/„/Telephone: <br /> Address: Pz O , a e Iva -91 S Nom`/y C/4- 7EZp t <br /> C. LOCATION AND DATE .OFF DISCHARGE <br /> Location: / <br /> epQ /+ <br /> (Best Physicalescription) (Cit or County) <br /> Date of Discharge:_. 9-72--Sr <br /> y �ZZ--,Pr <br /> Date Notified: d-Z2 S0 Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business <br /> ,,(( oir <br /> Contact Person: U�lLL ,Ei�jSO/1� Z/01?Telephone: ) �00 <br /> Physical Address: xqQ <br /> E. DESCRIPTION / <br /> Type Release: N,fJ Cyyt�ir�,i �a�p �i�s fP vi <br /> Volume: a C <br /> Chemicals: <br /> F. ACTION TAKEN SP►LL <br /> I-v4 j Q r O civ <br /> r-(/Ms fa Uu/c4 <br /> Liwv,/e,G Le u K �^ ✓ ,r <br /> p C c. u r-+�c� <br /> � �lu.n C05- eonile c- 4--(- c( <br />