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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 <br /> (Circle One) HEALT11 DISTRICT LOG q <br /> B • SOURCE OF INFORMATION <br /> Original Source: oh <br /> _ Telephone: <br /> Reporting Agency Name: — 1 <br /> -�Tf'ti /��.s���,ti Lor•, t.�� <br /> Agency 7 <br /> 9 y Contact: � - <br /> Address : Telephone: <br /> U <br /> C- LOCATION AND DATE OF DISCHARGE <br /> fi <br /> . <br /> Location: 7 <br /> Best Physical Description) <br /> Date of Discharge <br /> I , (City o County )" -- <br /> . <br /> - Un Kno w n <br /> Date Notified: 7 O <br /> O Of/ <br /> Time: <br /> D• '2L•'SI'OIJSiBLE PERSON/BUSINESS <br /> n <br /> Name Of Business <br /> Contact Person: h <br /> elel.,hone: ( ) <br /> Physical Address: A777 <br /> I UL:SC1tIPTI 0N C( <br /> Vo 1 Wile : -- -- <br /> u h/1 �� c - <br /> I \C T I Qt4 TAKI;IJ _ ---- <br /> f <br /> �Z L�12/ ➢ � �.. 'plc/, <br /> el <br /> 0 <br />