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SAN JOAQUIN COUNTY <br /> NOTIFICSON OF HAZARDOUS WASTE &CFL4'C',;E, <br /> IIEALTI I & SAFETY CODE 2S180.7 <br /> Ek°x <br /> A. EMERGENCY LEVE : I II III PHS-EH LOG # 9 D <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: ' kc N <br /> . � Telephone: <br /> Reporting Agency Name: N cr.� / �,,,�, Pti� e ,,./ems <br /> Agency Contact: f��� & Telephone: ft 3/yp <br /> Address: 64 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: t� �p� / <br /> (Best rl;ysical 6 scti tion <br /> p ) (City or County) <br /> Date of Discharge: --1J"AkA0t4v <br /> Date Notified: <br /> D Time: ;Lss AM <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business --5h-grne Arm, ,hof" <br /> Contact Person: -&/ 2� g Telephone: (E ) <br /> Physical Address: <br /> E. DESCRIPTION s.J cc+u�-�c� c� s �a• u6 sTs <br /> Type Release: <br /> Volume: -66,. A4v.✓ <br /> Chemicals: 1 /�vj►, Lc�r,��s /�9��y - s - <br /> F. ACTION TAKEN <br /> / ve oela <br /> � <br /> �VP-C <br /> EH 22 013 (Rev. 02/90) <br />