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SAN JOAOUIN COUNTY - . <br /> NOTIrICAi ONOI ��� CODE TE CIIAItGE <br /> `ill 111 \� <br /> n„ <br /> A. EMERGENCY LEVEL' I II I <br /> II PHS- -H L G # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION( <br /> Original Sourec:4L-e dem (r4U-i LA Nn Telephone. (2TII,, <br /> �+-n/ c7nfl�uiliiJ O �"LA �IILS'�1� l(� } <br /> Reporting Agency Name: 0� G K ? 2- 0 <br /> Agency Contact: N ;L So rJ Telephone: (2 ) <br /> Address: L 0 ° <br /> 2 /��v�✓ c 9SZo / <br /> C. LOCATION AND DATE OF DISCI-IARGE <br /> Location: 3 -7 7 t/ �/✓ rQ/f�/%//i>r �� C� <br /> (Best Physical Description) (City or C nty) <br /> Date of Discharge: ° -1 <br /> Date Notified: S &- 12 Time: Od <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business i <br /> (-e KAr2 0(ez a va <br /> Contact Person: SCCA Telephone: <br /> Physical Address: <br /> E. DESCRIPTION <br /> Type Release: ) A P <br /> Volume: U N V-PA oL,3 n I <br /> Chemicals: rP +✓dlevkw In�/ �YoCdtR�oriS <br /> F. ACTION TAKEN <br /> �i/� i;,v / C�/fi`fc°s' I�SGo�fS i'e✓2�i � •�✓ �/cr �'a M <br /> ,G mac' Si �SSt'S5 ��ti LGbe le r e cI ' <br /> ,�ge•�O.�Ln/<�2 ��C, ��1��/'P �l�G+' 2�C �v. 7` l/.� <br /> 4,n k) I AAA ki rz.-N/,Se-y -7A e <br /> El-1 22 03 (Rev. 7/89) <br />