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SAN JOAQUIN COUN'T'Y <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> L.r HEALTH & SAFETY CODE 25180 . 7 <br /> A. EMERGENCY LEVEL: FI JII TII HEALTH DISTRICT LOG � <br /> (Circle one) �/ <br /> B. SOURCE OF INFORMATION <br /> III <br /> Original Source: Telephone: <br /> Reporting Agency Name: sP/11- C'. <br /> Agency Contact: Telephone: PIT) <br /> ,. <br /> Address: , 0, 6 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 3-5 �w- - _L 600 <br /> (Best Physical Description) (city or Co ty ) <br /> Date of Discharge: �' I ,3 l gY <br /> Date Notified: 5 Lp` Time: o <br /> `-' D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business Dv tw Flee f ser ui-Ge— <br /> Contact Person: 1-1)nr) Jgp 0 Telephone: '— <br /> Physical Address : <br /> E. DESCRIPTION <br /> Type Release: ,� nI <br /> Volume: <br /> Chemicals : " <br /> F. ACTION TAKEN <br /> ze r e cc�a�� �,s'd�� tc�,L,� -Fcc.1 -,e,/p rec(:S i <br /> a <br /> k1t <br /> �lIVZ��/r�,uiy� a b�i`�.Vi cr S /tc,2 <br /> ` a � .� <br />