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' f <br /> SAN JOAQUIN COUNTY l <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> r HEALTH & SAFETY CODE 25180 .7 <br /> A. EMERGENCY LEVEL: II III <br /> (Circle One) HEALTH DISTRICT LOG # <br /> B. SOURCE OF INFORMATION <br /> Original Source: 1YlLLt>0 1 -. _ Telephone: ( _ <br /> Reporting Agenc Name: <br /> Agency Contact: � � Telephone: {,��J } q-6 -IL <br /> Address: <br /> L <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: <br /> (Best Physical Description) ' (City or County) <br /> Date of Discharge: ` - <br /> Date Notified: <br /> _ Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business L <br /> Contact Person: �� � Telephone: { ) <br /> Physical Address : Acy-�-2 �u <br /> E. DESCRIPTION <br /> Type Release: a) � <br /> Volume: <br /> 7 <br /> Chemicals : <br /> 1 <br /> F. ACTION TAKEN <br /> )�! M- Ten s <br /> LO <br /> cam) <br /> I <br />