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r. <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A- EMERGENCY LEVEL: I II III <br /> (Circle One) HEALTH DISTRICT LOG q ,apdi <br /> B. SOURCE OF INFORMATION <br /> Original Source: Q�d 1 <br /> Telephone: (2_q ) 4eG 2 <br /> Reporting Agency Name: <br /> ^ L.�i Nea lig O:rl ;�7 <br /> Agency Contact: <br /> D ,Ls Telephone: (209 <br /> Ybe-•Svvo <br /> Address: ((00 <br /> 2�� S��•1a,, c `tsLo i <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location. S, <br /> - II Il.Y1n <br /> (BestPh <br /> �a� Description) <br /> r �. (City or County) <br /> Date of Discharge: . <br /> Date Notified: <br /> Time: k o <br /> D- RESPONSIBLE PERSON/BUSINESS <br /> Name of Business ------------ <br /> Contact Person: 1`ob<^t Fow(� <br /> Telephone: ( 2aa) K62 -6sro <br /> Physical Address : f2l( <br /> E- DESCRIPTION <br /> Type Release: <br /> Volume: / <br /> Chemicals : <br /> GL <br /> F. ACTIOO T KEN <br /> Tan �`�rnova soil Ipsvlfs mvealeG( <br /> F . +l e z '�t yes<tswe L.'N L ,ny ', A A0 c�e} <br /> tLf <br /> La,, Ao (- A <br />