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SAN JOAQUEN COLTNTY FILE COPY <br /> NOTIFICATION OF ELA7-ARDOliS WASTE DISCEL-kRGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: IO II III PHS-EH LOG T _ �Q • ��O <br /> (Circle one) <br /> B. SOURCE OF INFORMATION <br /> Name: c7 o <br /> Phone: �) 3'S 3 I � �v_ <br /> Company: <br /> Address: r r� <br /> Designated Employee dame: C) L ra Phone: <br /> 20S- 69-0333 <br /> Reporting Agency Mame: - l _ <br /> Address:.. -5oQ . <br /> C. LOCATION AN-1) DATE OF DISCH.IRGE <br /> Location: <br /> , 1 { s0-n �OGc J vs,! ��I-�' r►"" 9 <br /> (Best Physical Description) (City or Coun Circle one <br /> Date of Discharge: q- (,:--)—0 Z7 <br /> Date Notified: Oro Time: <br /> D. RESPONSIBLE PERSON/BUSINESS �f <br /> Name of Business: r <br /> Contact Person: Phone: I <br /> physical Address: <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: Ong .A_� ��-��- <br /> Volume: I)II <br /> Chemicals: S <br /> Circumstances: r, �'_ r, ` ` <br /> Or b- <br /> F. ACTION TAKEN • { rC7 <br /> SITE DISPOSITION_ lel;_ <br /> ER 22 0 13 (Rei'. 03"20/98) <br />