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• SAN JOAQULN COUNTY • <br /> NOTIFICATION OFaAZARDOUS W.-%. DIS <br /> _- HF_aLTH 3c SAFETY CODE ZS1?SI30.7 <br /> A. ENIERGENCY LEVEL: I^U M PETS-E-: LOG 3 IFL ! <br /> (Circ!e one) <br /> 3. SOURCE OF NFOtZ-NLATION <br /> /' <br /> Nae: // 1l / <br /> y � Phone: ( ) <br /> Company All <br /> Address: z 2z so v,'m ?I-AZA <br /> Designared unuloye-- .Name: Phone: <br /> Reporting .agencyName: 5 A-lu <br /> .address: <br /> C. LOCA11ONAND <br /> DATE <br /> -OFD(SCILAAGE� <br /> Locarion: - / G � J/4('(4/I <br /> (Best Physical Descnacoa) i nunry irc!e one <br /> Dare of Disc3arge: L//C!C/1/C`%')/Ll <br /> Dare Nociaed: S/ 2 i 9 9 Time: <br /> D. 2ESPONSIBLE PF-RSON/BUSINESS <br /> varve of 3usiness: � �4!/ivar1Az (7;%A <br /> ✓Contact P-soa ,7 e:(5 26�5 PFtiPcef—1 ?Sone: = 20-7 <br /> ?�vsicai Address: 222 $e v'G! e:vEZd,U6 a� 2A 1 r 0 C CHI( 60 <br /> (ailing .address: r At3:: = 6cE <br /> _. DESCRr3TION <br /> Tvoe ofDisc-" ge: <br /> �i:oiume: ui/1.' <br /> Cie niccz: C-A 2Rntil Tc%,e,4 c'H C(S 2 /.0c iV Ole/NK/R/b W6<4 0n) S1; <br /> Cirv4mstonces: e>og/ lu 5/ � Rs> s=R ict i OAQIOIS <br /> '.UA' <,a!4 PG c`S' <br /> 6v<F7c�2 r7;6Vr'-r OCMcIT( C Cmc% ;- HoLk)jnl67 fFnF- w/i / rl <br /> F. ACTION T.aK-N COi N SCTs io c�c« <br /> r LG '7 <br /> S= DISPOSITION w,Ct:ri'4- A55e-S5tit6y r 0 r CA Mod TEre/♦Cl Wu) <br /> err)c=D NI C C cil 7 L <br /> tF✓•hi✓- <br /> A�< 2 3c;, RPh u- ?G noo <br /> ?: <br /> ?)!l (Rev. 03,_0/93) <br />