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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: C +��� <br /> ----.---____-_`� - Telephone: (Ql6 <br /> Reporting Agency Name: -Sac- ,.,M Lot, t )-le�t_tt, p;S{ <br /> Y•[ <br /> { <br /> Agency -Contact: Telephone: Ybrr- swa. <br /> Address: rboi F_ , HG 4.tl or. Q.o. �ax 20, C_ �} eta z4r <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: <br /> (Best Physical. Description) (City or County) <br /> Date of Discharge: �,���a•.-� <br /> Date Notified. 3�fr �tf Time. R:00 g <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> -, t <br /> Name of . Business V w�4� o; QJ4i[1C S�y"M:G. # ?_�S� <br /> Contact Person: L . 3 . 5q : ., Telephone: <br /> Physical Address : flogs R j zo 4 <br /> E. DESCRIPTION <br /> Type Release: (JnAe✓ rv�.cL S la.q i... <br /> a <br /> Volume: <br /> Chemicals : <br /> F. ACTION TAKEN - <br /> (A L <br /> AKEN {AL <br />