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SAN JOAQUIN COUNTY <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: Telephone: ( )�kAIt <br />- <br />Reporting Agency Name: <br />Agency Contact: ` - Q ,,J Telephone (2vA) <br />Address: <br />MORN <br />C. LOCATION AND DATE OF DISCHARGE <br />Location: c> , , / <br />(Best Phy ical D scription) (City 3rnty) <br />Date of Discharge: �'� <br />Date Notified: \--\-\ Time: kAC.uv <br />D. RESPONSIBLE PERSON/BUSINESS <br />Name of Business 0 1 - <br />Contact Person: k e-. Q_VSt,5 Telephone: () 44— <br />Physical Address: _C vk'f u 5 �C "�T A z® <br />E. DESCRIPTION 1 <br />Type Release: ta.a- <br />Volume: A, <br />Chemicals: ' t® - `1- <br />F. ACTION TAKEN <br />