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t SAN JOAQ{�I COUNTY <br /> NOTIFrRION Orr OUS WASAISCHARGE <br /> HEALTH & SAFETY CODE 2S I80>, , <br /> A. EMERGENCY LEVEL✓ II I1I PHS-EH LOCI _ Q . <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: ('tig Telephone; -3 <br /> Reporting Agency Name: ti ' <br /> A icr <br /> Agency Contact: s �• Telephone; <br /> Address: A oN 'f <br /> C. LOCATION AND DATE OF DISCHARGE . <br /> Location: ; <br /> (Best Ph sialescri tea' � '— <br /> P n) (pity 0r Comity) <br /> Date of Discharge; �k <br /> w q <br /> Date Notified: _ <br /> -0/11;& Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of BusinessL <br /> Contact Person: ®L�! Telephone; <br /> Physical Address: <br /> E. DES ON <br /> '4pe Release: <br /> Volume: M NObc n� <br /> Chemicals; <br /> Fs AC17ON TAKEN <br /> i,-a ,tit <br /> EIS 22 013 (Revs 02/90) <br />