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—; � <br /> 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 1 JZL.�_ <br /> �%l,{J)�cl C0'�[C�LTelephone: <br /> Original Source: <br /> Reporting Agency Name: 5 .1• �' ' 4' L. <br /> Agency Contact: 404VL. .c.. �- J Telephone: ( ZalN) 4f63V-2,0 <br /> Address: RCS � 2-601 <br /> & )'` v�•J1C� . <br /> C. LOCATION AN <br /> D DATE OF DISCHARGE / <br /> Location: f ! q3 <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: <br /> Date Notified: �� 88 Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business ,)ELT-;q /(('��14a <br /> Contact Person: / Telephone: ( ) <br /> Physical Address : D J14 GW` 1,0 <br /> E. DESCRIPTION <br /> Type Release: � t1 6"r•T• <br /> Volume: t` <br /> Chemicals: G <br /> F. ACTION TAKEN <br /> A <br /> �� tf <br /> � taut c.c, <br />