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o cA& SANJOAQUIN COUNTY <br /> EN'PkONMENTAL HEALTH DEPART1111INT <br /> 304 East Weber Avenue, 3rd Floor,Stockto A 95202-2708 Ion <br /> (209)468-3420•Fax.(209)464-0138• Web: o lea ui us/ehd <br /> ICI A S D 'SC r <br /> California Health Safety Code, Section 25180.7 'J` <br /> EHD LOG#: - 0I <br /> A. EMERGENCY LEVEL: 10II III <br /> (Circle One) <br /> B. SOURCE INFORMATION <br /> Name: Phone: ( 2) 2-7-7-w-2766 <br /> Company: +'� c v�Ge r` ►� <br /> Address: nS C ty: VA Zip Code: I D 7 <br /> Designated Employee Name: <br /> Reporting Agency Name: <br /> Address: City: Zip Code: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 3 9 q 0 ' r a -F>( J SL' T rk c c.V- / City or County <br /> (Best Physic escription) 0 (Circle One) <br /> Date of Discharge: aJ r, Date Notified: *31-2510'3 Time:_ /0 P.m. <br /> D. SPSIL PERSON/BUSINESS <br /> Name of Business: -T—eA cm- ` A c.. -'� j 4v {� L,L <br /> Contact Person: G t'ccr °� �" 1 , t A Phone: ( ) <br /> Physical Address: 3 q q 0 W"'Tr"N S 1l/', City: f A c-J..- Zip Code: <br /> Mailing Address: City: Zip Code: <br /> E. DESCRIPTION <br /> Type of Discharge: a <br /> Volume: t r d vJ <br /> Chemicals: Les e , <br /> Circumstances: * QLa p e.r' <br /> F. ACTION T `a e-k <br /> SITE ISPSITI U-5 T <br /> t ar. Ul R R �-"' Led l_ocu ( ® tl�-s to�f r�5rant <br /> -fir,r r t n J e-3--t G e,4j d rj <br /> EHD 22-02-003 <br /> 10/2/2003 Notification of Haz Discharge <br />