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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180 . 7 <br /> A. EMERGENCY LEVEL: Il III HEALTH DISTRICT LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: Telephone: 76112� <br /> Reporting Agency Name: <br /> Agency Contact: fj Ivf S —T17'7AI'r1/U Telephone: <br /> Address : 2000 VV, <br /> , <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 2n% lit/, 71"r it. / �G(i <br /> (Best Physical Description) (City of County) <br /> Date of Discharge: 40A11by011y/✓ <br /> Date Notified: Time: d/?)ti� <br /> D. RESPONSIBLE PERSON/BBUSINESS <br /> Name of Business W'Pz-&� /V/�/f <br /> Contact Person: ZifGs Telephone: (/,4�7) 33 y 7oZS� <br /> Physical Address : 24:0 <br /> E. DESCRIPTION <br /> Type Release: - <br /> Volume : l��� � �1 ��11 0 r-4 S <br /> Chemicals : <br /> ((gg <br /> F. ACTILC4TA <br /> N <br /> K �o Vnp� %h UGST T f � �l ✓ � <br /> 0 2/,, 7 <br /> 7/4 <br /> Owner is �.,� ��, < in% ���� � ,p/�-rr � l'��ro✓e <br /> C 0 L� <br />