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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180 . 7 <br /> A. EMERGENCY LEVEL: II IIIg�'j / rj� <br /> (Circle One) HEALTH DISTRICT LOG # <br /> B. SOURCE OF INFORMATION <br /> • Original Source: � �J Fti;�� <br /> Telephone: <br /> Reporting Agency Name: I � � r� �i�7�� D �A <br /> Cp/yt- �Ty�Q <br /> Agency Contact: <br /> Telephone: (22I) C/ d <br /> Address: ( SaU <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: �� 4/3 /U. /d-fj,/N � / C a-4'1(Best Physical Descri tion) J o <br /> P (City or C nty ) <br /> Date of Discharge: !tip l <br /> Date Notified: �� j � � g <br /> Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business �j _ �( lei <br /> Contact Person: , <br /> Physical Address : <br /> E. DESCRIPTION I VL 4D Cte S*J ems•, <br /> Type Release: _ 'i7 ljdzu-4, z z <br /> Volume: <br /> Chemicals: f�D�e�i�v�i <br /> F. ACTION TAKEN m�agire T, <br /> v <br /> rn�A,1 r Pavy <br />