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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCH <br /> HEALTH & SAFETY CODE 25180 . 7 C(0 [py <br /> A. EMERGENCY LEVEL: II III <br /> (Circle One) HEALTH DISTRICT LOG <br /> B. SOURCE OF INFORMATION <br /> Original Source: Telephone: <br /> Reporting Agency Name: 30�,,,It d'Qo ' <br /> Agency Contact: r ; e C& ]I f/ Telephone: <br /> Address : 0, a 00 9S- O l <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 30 /1/ qh, S� j•�f / 5�. o Gz , <br /> (Best Physical Description) (City or C nty ) <br /> Date of Discharge: 2Y -116 — 91? <br /> Date Notified: a /a Time: '(� <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business Q l,, © y� r W/o r <br /> Contact Person: pyU j) .�Dp Telephone: 00Z ) �— <br /> Physical Address : I-- <br /> E. DESCRIPTION <br /> Type Release: /101 <br /> Volume: <br /> Chemicals : r 02zj1d, w <br /> F. ACTION TAKEN <br /> orl /,7�s revev-�' � b � � _ <br /> � c <br />