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s <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> f <br /> A. EMERGENCY LEVEL: C, II III HEALTH DISTRICT LOG #�F�—Qpel/ <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: �( j _ �� , �sp� Telephone: ) _ <br /> 2 <br /> Reporting Agency Name: <br /> Agency Contact: <br /> Telephone: <br /> Address: (�fj�� � 1�ja-A-�.� �,. oC-�?'��J <br /> C. LOCATION AND DATE OF DISCHARGE , <br /> Location: ��� R� �- � GY <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: IukaJA�j�� <br /> Date Notified: 0 Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business �j}S(� ��� r S���r���� ����.Eu►'Y� Cerx.P►t��f <br /> Contact Person: �. t6a'Fs+�D Telephone: <br /> Physical Address : <br /> E. DESCRIPTION <br /> Type Release: �).)f111tY1$2.1 1 k ;fit, 'i'f$Nk uIJDT-�LlnrLButJDS�t�,ktaET K <br /> Volume : uwy-fo � <br /> Chemicals : CJrtI�G <br /> F. ACTION TAKETJ : 7HMJKS ( V1�Jvt� ASA c�tt✓/wftTE t ►►�hc�45E Lp ��W�- <br /> Go�r-��tvYtl t`1►4�-1�, ` <br /> s 8% E yr W t LL �F tQ a►(k—► 19 ��5 Ck.l�1 c <br /> lam. --.� ((4r— - An <br /> � SOA Roytu/�G t'�uc.�-ce-asr Ih-tp�C�{ <br />