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SAN JOAQULN <br /> UNTY <br /> NOTIFICATION OF HAZAROUO <br /> DS WASTE DISCIAKIs►f. COPY <br /> HEALTH & SAFETY CODE 25180.7 2 <br /> A. EMERGENCY LEVEL: 1I III PHS-EH LOG n QJ -05C� <br /> (Circle one) <br /> B. SOURCE OF INFOR-MATION <br /> Name: 6� S"�t� <br /> Phone: (QDi) � � <br /> Company:GaO\)vQ <br /> T <br /> Address:\ \ `� Phone: <br /> Designated Emplovee Name: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE. <br /> Location:a' a-2v- \)S -J\C3 OK2- � / ( (City or County) Circle one <br /> (Best Physical Description) <br /> Dace of Discharge: ,� Time: \fl"E� <br /> Date Notified:_ 5 G" <br /> D. RESPONSIBLE PERSON/BUSINESS 11 <br /> dame of Business: <br /> PhoneO°t��\vt5; <br /> Contact Person: ON\.] c\NE� ` <br /> Phvsical .address: <br /> vlailing Address:` FRp1.'�- `J <br /> E. DESCRIPTION <br /> Type of Discharge:v <br /> Volume: u+�k�� <br /> Chemicals: <br /> Circumstances: <br /> F. ACTION TAKEN RE�C-Rs�rO "� <br /> Wer+V eS\G.\?zC czzrv'�os <br /> SITE DISPOSITION TO YiS�Ck---"N� <br /> EH 22 0Ii (Rev. 03/20/93) <br />