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�.. SAN JOAQUIN COUNTY .. , <br /> NOTIFICAHIALTH & SAFEOF TDYOCODE 25180.7 US WTE CHARGE (( opy��j <br /> A. EMERGENCY LEVEUCLIII III PHS-EH LOG # 6 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: / e0 Phone: 7(6 )(o76-.moi 46 <br /> Company: C <br /> Address: f,V too 3 a C O u -6 0 3 <br /> Designated Employee Name: c i' - a s Phone: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 561 W. <br /> (Best Physical Description) Ci or County) Circle One <br /> Date of Discharge: - -,qD — '?/, <br /> - <br /> Date Notified: 7 -�A =. '71 L Time: 3;00 p;�u <br /> D. RESPONSIBLE PERSON/BUSINESS _ <br /> Name of Business: P1LPi$ i cr e- cC�i L°3^ L <br /> Contact Person: Telephone: (_) <br /> Physical Address G << 1 Q- '�� -� CIS _K0 <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: 3 -11- ar <br /> Chemicals: > <br /> 6, <br /> Circumstances: 7- - <br /> C1 0 <br /> F. ACTION TAKEN <br /> SITE STATUS <br /> <Mr7 " I-LqR , <br /> EH 22 013 (Rev.4/91) <br />