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9 SAN JOAQUL`1 COUNTY 0 <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARTIL E COPY <br /> HEALTH & SAFETY CODE 25180.7 f y // <br /> A. EMERGENCY LEVELV II III PHS-EH LOG <br /> (Circle one) <br /> B. SOURCE OF NFOMATION <br /> Name: CJ Y� t�r . ��k;ree�) Phone: (�� � 12q <br /> Company: <br /> Address: <br /> Designated Employee Name: Phone: 62Dy) Y,6 <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> LoCJ tY ort f A)� +� S'Lo G IIJS <br /> Location: � I� T � � e�-� l <br /> (Best Physical Descn no itv or County) Circle one <br /> Date of Disc11211-2e: -3 D <br /> Date Notified:_— D-0 Time: <br /> D. RESPONSIBLE PERSONBUSNESS <br /> Name of Business: <br /> Contact Person: Phone: <br /> Physical Address: <br /> ;✓[ailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: Z <br /> Volume: c <br /> Chemicals: <br /> Circumstances: <br /> a <br /> F. ACTION TAKEN <br /> i <br /> L <br /> SITE DISPOSITION s5L <br /> A <br /> EH 22 0I3 (Rev. 03/20/98) <br />