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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180. 7 <br /> A. EMERGENCY EVEL: II III HEALTH DISTRICT LOG D <br /> (Circle One) �r� <br /> 0 <br /> B. SOURCE OF INFORMATION <br /> Original Source: Telephone: <br /> Reporting Agency Name: o J <br /> Agency Contact: <br /> Telephone: (LcZ) Sl�cB 3f�S'G <br /> Address : <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: <br /> (Best Physical Descrip ion) (City or County) ' <br /> r 4 i <br /> Date of Discharge: n erxc <br /> Date Notified: - Time: <br /> D. RESPONSIBLE PERSON/BUSINESS ` <br /> Name of Business / <br /> Contact Person: Telephone: tom} <br /> Physical Address : � el <br /> E:. 1)L•:SCRI PTION <br /> Type kelease: / <br /> Vo l ultle : <br /> {_E11.:[1 ica <br /> 1". ACTION TAKEN � <br /> � <br /> 11� y <br /> C' . <br />