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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180 . 7 <br /> A. EMERGENCY LEVEL: �1 JII III HEALTH DISTRICT LOG <br /> (Circle One) 0 <br /> B. SOURCE OF INFORMATION <br /> /- e jp sY7 ICT <br /> Original Source: X621,(/h/ 2�� Telephone : <br /> Reporting Agency Name: -L1,4/ -7e14U iM <br /> Agency Contact: �/ S ,/ Telephone: �O�) �,f <br /> Address : <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 1;J20w / j <br /> (Best Physical Description) (City or C unty) <br /> Date of Discharge: Uit/ft/alryl✓ <br /> Date Notified: - 77tTime: 3r'd0 <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business ^) <br /> Contact Person: _247/v _ Com_ Telephone: <br /> Physical Address : —/32-0 <br /> E. DESCRIPTION ` <br /> Type Release: ii/�f iff7J Z F /�/;�se- <br /> Volume: �L�&JZA <br /> Chemicals : �P: C:eNe- 1 SI( <br /> F. ACTION TAKEN <br /> Q <br /> l <br />