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i <br /> ( <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> Health & Safety Code 4 25180.7 <br /> A. EMERGENCY LEVEL: I II III Health District Log N <br /> (Circle one) <br /> B. SOURCE OF INFORMATION <br /> Original Source: &,J-e F-<-t-tetd4G -rA. i , elephone: ((,05 ) S76C�Z9L <br /> Reporting Agency Name: (m..0- -T 4Z <br /> Agency Contact: ( Ir 4trA1S Telephone: <br /> Address: /�j CA <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Date(s) : /z-7 /8'7 Time: f;0014,1-C <br /> Location: wH <br /> (best Physical Description) (C ty of Coulty <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: <br /> Contact Person: Telephone: ( Z01) <br /> Physical Address: may/ 2/1 , .S-�?oc-Az� <br /> E. DESCRIPTION p D <br /> Type Release:-,d <br /> Vplume: <br /> Chemicals: <br /> F. ACTION TAKEN <br />