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1„rr- <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HA7.ARDOUS WASTE DISCHARGE <br /> Health & Safety Code § 25180.7 <br /> A. EMERGENCY LEVEL:0 II I1I Health District Log # 0 L /� <br /> (Circle one) <br /> B. SOURCE OF INFORMATION <br /> Original Source: . r Telephone: ( ) <br /> Reporting Agency Name: ( S <br /> Agency Contact: ` 4u- /Q_ Telephone: ( } Zj: 1�7-�� <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Date(s): Time: <br /> Location: / t-aC <br /> Best Physical Description City or Co ty <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: [�6f-Ir <br /> Contact Person: Telephone: ( ) 3 S 3 <br /> Physical Address: l C-a C- <br /> E. <br /> E, DESCRIPTION <br /> Type Release: — <br /> Volume: <br /> elease:Yo1ume: <br /> Chemicals: <br /> F. ACTION TAKEN <br />