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SAN JOAQUTi t COUNTY E DISCHARTEI L E COPY <br /> YO'1FICAT'ION OF ELAZARDO <br /> HEALTH g SAFETY CODE 25180,7 <br /> ' 4 <br /> A. EMERGENCY LEVEL: I II III <br /> PHS-EH LOG 3--d <br /> (Circle one) <br /> B. SOURCE OF INFOR_NLATION <br /> Name: Phone: <br /> Company: <br /> Address: 1 p Phone ?,sq <br /> Designated Employ_ee dame. <br /> Reporting Agency Name: �'r.�. �o.T,.�.;,� Ca <br /> P <br /> Address: D <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: P� itv or County) Circle one <br /> (Best Physical Descnpuon) <br /> Date of Discharge: Time: <br /> Date Notified: <br /> D. RESPONSIBLE PERSON/BLSNESS <br /> Name of Business: Pam ( lew- <br /> Contact Person: 4(�%k�u�`'�- 4S — <br /> Physical address: <br /> ,\/falling address: <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: <br /> Chemicals: <br /> Circumstances: ~ <br /> F. ACTION TAKEN <br /> SITE DISPOSITION <br /> EH 22 013 (Rev. 03/20/93) <br />