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... f <br /> SAN. JOAQUIN COUNTY ' . <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: II III HEALTH DISTRICT LOG. # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: �Sf <br /> Telephone: ( ) <br /> Reporting Agency Name: <br /> Agency Contact: Telephone: p ) <br /> Address: � d ��( �.Qp•/ ���=-��F)/� <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: <br /> (Best Physica Description) (City or aunty) <br /> Date of Discharge: own 1 <br /> Date Notified: Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business <br /> Contact Person: <br /> � ✓� � E'_S Telephone: <br /> Physical Address: <br /> E. DESCRIPTION 1 <br /> Type Release: <br /> Volume : «y� <br /> Chemicals : t21,v\ at — <br /> F. ACTION TAKEN <br /> i <br /> • r <br /> r r <br /> d <br /> Li <br /> -3 <br /> i <br />