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r� <br /> P f <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180 . 7 <br /> A. EMERGENCY LEVEL: II III HEALTH DISTRICT LOG # 3?)-Ow-3, <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: Telephone; <br /> Reporting Agency Name: STS . <br /> Agency Contact: G� Telephone: ( 4 �t ?(a e <br /> Address : 0, <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 7 <br /> y ` <br /> (Bestysica Description) ( ity or County) <br /> Date of Discharge: A40vvl-� <br /> Date Notified: 4eg--� Time:/ <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business <br /> Contact Person: <br /> Lit <br /> Telephone } <br /> Physical Address : � <br /> E. DESCRIPTION <br /> Type Release-.. <br /> Volume: <br /> Chemicals : <br /> F. A T I O N TAKE N Cj p i -C,o) +D-r (/e L( 'Cd <br /> Com) <br />