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SAN JOAQCEN COU-NI TY <br /> NiOTTFICATION OF EL-kZARDOUS WASTE DISCEL <br /> HEALTH & SAFETY CODE 25280.7 `1 M__ E COPY <br /> A. EMERGENCY LEVEL-.()I 1I III FHS-EH LOG <br /> � � • fJ <br /> (Circle one) <br /> B. 'SOURCE OF INFORMATION <br /> Name: �- E=11 L�(�i'1Jy! rj _ Phone: W,017-2 <br /> Company: <br /> Address: Phone: �D�! <br /> Designated Emplovee Name-. L2 � � <br /> Reporting Agency Name: <br /> Address: r <br /> C. LOCATION AND DATE OF DISCHARGE <br /> VL <br /> I.oCaL10R:�, (Civ, Counrv) ircle one <br /> (Best Phvsical Description) <br /> Date of Discharge: <br /> Date Notified: Tune:_ %L'� P�.•� . <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: Phone- ZO <br /> Contact Person: G-�,a� Jr <br /> Phvsical Address: <br /> vlailin; .address: <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: <br /> Chemicais: <br /> Circumstances. <br /> I <br /> F. ACTION T.kKEN <br /> ot <br /> SITE DISPOSITION <br /> EH 2'_ 013 (Rev. 0&20193) <br />