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, <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180 . 7 <br /> A. EMERGENCY LEVEL: 0 II III HEALTH DISTRICT LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: a:�- �c/r�!/� Telephone: (,4`J ) X68�31C� <br /> Reporting Agency Name: `S?y�u'y/�Cc1cJi j! hltw .z Jrsi,P,GT _ <br /> Agency Contact: k 191/91K f vizlV Telephone: ( ) <br /> Address: /061 _,�3�' 200`I -_5%0GC7-0.CJ 01� 5.s2U! <br /> C. LOCATION AND HATE OF DISCHARGE <br /> Location: ZX9CO &_ _ /o2CJ / eA�IJ�Uy <br /> (Best Physica4 Description) (City or County) <br /> Date of Di-scharge: �ht)le�tjd <br /> Date Notified: /– Time: _j? <br /> ? <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business <br /> Contact Person: >/ . s Telephone: y/// <br /> Physical Address : <br /> E. DESCRIPTION <br /> I <br /> Type Release: U4 le— <br /> Volume: <br /> e-Volume: <br /> Chemicals,, : 19 1 i <br /> F. ACTION TAKEN <br /> XK <br />