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SAN JOAQUIN COUNTY ... y <br /> NOTIFICATION. OF HAZARDOUS WASTE DISCHARGE <br /> • HEALTH & SAFETY -CODE; , 25180,_7 <br /> A. EMERGENCY! LEVEL: II III HEALTH 'DISTRICT, LOG .# <br /> " (Circle; One) <br /> B. SOURCE OF.' INFORMATION <br /> Original Source:-. N VA , A osafz Telephone: <br /> Reporting:. Agency Name: 5 JO&Qt I I L0CA3.. � wi&cv­ <br /> Agency Contact: . 13 Telephoner ( )4(00-3 1 <br /> Address: EC) <br /> #Dec:. 7 � SX0 } CA- - 5l0i ^ <br /> C. LOCATION AND DATE OF , DISCHARGE i <br /> Location <br /> (Best Ph sical Description) (City or''County) <br /> , <br /> Date of Discharge: U ov-00wIJ <br /> Date Notified: l Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business <br /> Contact Person: (' t S LwL-Da= !Telephone: <br /> Physical Address: W00 <br /> E. DESCRIPTION <br /> Type , Release: Uoka_T-�12�� LLE.Le.E, <br /> Volume: (� <br /> Chemicals t Lia <br /> F. ACTION TAKEN <br /> ca` <br /> i� c9w C - <br /> P f Lo P R-c t Y <br />