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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 'S <br /> (Circle One) <br /> B. SOURCE OF INFORMATION / <br /> Original Source: <br /> Telephone: y <br /> Reporting Agency Name: <br /> Agency Contact: / Telephone : ( c4) (l - 3u2 o <br /> Address : 12 6. T y <br /> �! C. _LOCATION AND DATE OF DISCHARGE <br /> Location: /� /�• / 4�C C . <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: <br /> Date Notified; Z Z <br /> � Time; <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business �p <br /> Contact Person: s Telephone: Off ) 3G�'G6 7b <br /> Physical Address : 72,6 <br /> L. DESCi2IPTION <br /> TYPe Release U. A <br /> Volume : ,_ <br /> Chemicals : <br /> F. CTI 0N TAKEid <br /> /Iwt <br />