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' f T FILE COPY <br /> SAN JO�QLIlr COUNTY <br /> .NOTIFICATION OF M_ZARDOtiS W�►STE DISCH_-�RGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL II III PHS-EH LOG T (00' <br /> (Circle one) <br /> B. SOURCE OF INFORMATION <br /> 73 <br /> Name: <br /> Phonfl("O) / — j <br /> Company: <br /> Address: Phon " <br /> Designated Employee Name: <br /> Reporting Agency Name: 0I <br /> Address: D <br /> C. LOCATION AND DATE OF DISCHARGE L <br /> Location: /,�O�0 / S '� � <br /> (Best Ph-,-sical De npcion) r County) Circle one <br /> c <br /> Date of Discharge: Time: <br /> Date Notified: ZG' <br /> D. RESPONSIBLE PERSON/Bt;SINESS <br /> Name of Business: <br /> Contact Person: <br /> Physical address: s , <br /> [ailing address: <br /> E. DESCRIPTION JI <br /> Type of Discharge: <br /> Volume: 7 �' <br /> Chemicals: IP <br /> Circumstances: <br /> F. ACTION TAKEN <br /> SITE DISPOSITION Avg it/ <br /> EH 22 013 (R,-v. 08/20/98) <br />