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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180 . 7 <br /> A. EMERGENCY LEVEL: � I II III HEALTH DISTRICT LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: ats. -,(� 5Telephone: (ZJ9Z1�6 <br /> Reporting Agency Name: <br /> Agency Contact: kAzzl, Telephone: ( ) V(,Y'3Yt v <br /> Address: '126 •l��yC 2005 STK 4 Szo/ <br /> C. LOCATION AND DATE OF DISCHARGE ` <br /> Location: 2-01 22&,�,d, b n . , Sf <br /> (Best Ph sicalDescription) (Ci vor County) <br /> Date of Discharge: <br /> Date Notified: 1- (�-�� Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business �• T �� �� <br /> Contact Person: � c�.� Telephone: oo0 ) -��61 <br /> Physical Address : <br /> E. DESCRIPTION <br /> Type Release: /� -� �'�- cz v' {�,•�12� <br /> Volume: <br /> Chemicals : <br /> F. AC-T�I�ON TAKEN/ <br /> occ vrr-c o n q rovrtrj �ice 4.�'1G� cUarrLe� <br /> i r Ct a o �- w ee- s e,> �-f-�1 , l2�-F e-r' rads rna d c fo <br /> -�y/` a,,l DT7 s —T-SC-_0 �D� -�Cf-104) (,V t 5 �rt <br /> c 1-k Ir. j Oj e-x 1-1 G a�)•C r � �F- -s 4 c-- Lt S S <br /> O � <br />