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SAN JOAQUIN COUNTY ' L E COPY <br /> NOTIFICATION <br /> EAL H & ZAp�DOUS WASTE SAFETY CODE 25180.7SCH� .R <br /> A. EMERGENCY LEVEL II III PHS-EH LOG 4 O 1 - O? 2L <br /> ircle one) <br /> B . SOURCE OF INFORMATION <br /> hone: (24 <br /> Name : / l.. , 7 a CL- _ <br /> Company: c� 7 L <br /> Address: } <br /> Phone: tan 'V- 346'I <br /> Designated Employee Name: <br /> Reporting Agency Name: <br /> Address : <br /> C . LOCATION AND DATE OF DISCHAR .G-¢E- CC <br /> i1 <br /> Location: i i '1 w�f / J1 : (Cin r County) Circle one <br /> (Best Physical Description) <br /> Date of Discharge: Time: % �J <br /> Date Notified: <br /> D . RESPONSIBLE PERSON/BUSINESS <br /> m _� el� i�ie 'eS <br /> Name of Business: Phone: � © / a <br /> Contact Person : <br /> Physical Address : u e <br /> Mailing Address : )=f X ' t c,4 �f$' r'? 67 <br /> E . DESCRIPTION / (k <br /> Type of Discharge : <br /> Volume : 6141 ryy <br /> Chemicals : ti Zf <br /> Circumstances : <br /> F . A TION TAKEN <br /> � ess <br /> SITE DJSPOSIT ON <br /> EH 22 013 (Rev. 08/20/98) <br />