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SAN JOAQUIN COUNTYO O <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARG OO <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: OIII III HEALTH DISTRICT LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: a/ f % � Telephone: d�) q67-2L <br /> Reporting Agency Name: S sS 6. a-8 _ <br /> Agency Contact: ZA,14,1L Telephone: (7_65) x/68 3y7 p <br /> Address: P(J, <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: y761 kc� at,,( <br /> (Best F&Aysical Description) (City or County) <br /> Date of Discharge: <br /> Date Notified: 9 : t(T •.o{ • <br /> Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business &kwn„ <br /> Contact Person: / l Telephone: 0;") <br /> Physical Address : y <— 1--d� <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: <br /> Chemicals : <br /> F. I'C�TI�OpN TAKEN p n, W44- <br /> ��_ <br />