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ii <br /> SAN JOAQUIN COUNTY" <br /> NOTIFICATION OF HAZARDOUS WASit D [ SCf-LaRGE <br /> COPYHEALTH & SAFETY CODE 25180 . 7 <br /> � 4A. EMERGENCY LEVEL: I [I III PHS-EH LOG # 10 <br /> (Circle One) <br /> B . SOURCE OF INFORMATION <br /> Name : Phone: CLj. )A4c/ <br /> Company: fo <br /> Address : f) Lh S ��nu. >gz <br /> Designated Employee Name: Phone: �) <br /> Reporting Agency Name: <br /> Address : 1,jzGE2 � <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: /42 rno <br /> (Best Physical escripti n) (City-o ) Circle One <br /> Date of Discharge: <br /> Date Notified: Time: 2 ; pi!2 <br /> D . RESPONSIBLE PERSON/BUSINESS <br /> Name of Business : .(3LVvr-o 1 ,24,2 'a,a <br /> Contact Person: Telephone: (_) <br /> Physical Address : 1pi. 2To L . <br /> Mailing Address : a sri ( lk� , z Almsads n// 40 <br /> _. DESCRIPTION <br /> Type of Discharge : � lFzf nem 1.&7 E/IA1&uxw <br /> Volume : <br /> Chemicals : A r r s 07A / —lir 8 <br /> Circumstances :. lee g4cE A�m &/V f oudE , lzar w f2jz i <br /> ACTION TAKEN1� .� < C c 7,� mcdrA <br /> SITE STATUS �d �1L < 2�ancw �acl Gry <br /> r - 32 013 ( Rev . 4/91 ) <br />