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SAN JOAOUIN COUNTY j <br /> NOT N OF I-I VARDOUS WAST: aCIIARGE <br /> HEALTI-I & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG # - <br /> (Circle One) <br /> B. SOURCE OF INFORMATION �- 55 3 o <br /> Original Sourcc:Alg6�de,� [rFl l-+_f_r'�-�D Telephone: <br /> Reporting Agency Name: <br /> r ry F — <br /> Agency Contact; t t i L S d r Telephone: 2( d�_) d <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: -:5 -7 7 il,, 6:✓ <br /> >' (Best Physical Description) (City or C nty) <br /> Date of Discharge: ,U' <br /> Date Notified: - Z — Time: v <br /> D. RESPONSIBLE PERSONIBUSINESS D <br /> Name of Business <br /> Gex�Nc(ee u. ( . 3, iTri(�e fto <br /> Contact Person: S� me,. Telephone: <br /> Physical Address: <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: - L2 N KU QW r-N -- <br /> Chemicals: ef y C)ro C e�PA 0 ni-5- <br /> F. <br /> F. ACTION TAKEN <br /> LI Ide -41qd 526rdge- 7�1&1,xt-S k2_ <br /> Pte. L K irl z c zZ LIZ 74V <br /> EH 22 03 (Rev. 7189) <br /> i <br />