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SAN JOA QUIN COUWTY FILE COPY <br /> NO'TmCATION OF RA7_ARDOliS WASTE WSCHARGE <br /> HEALTH & SAFETY CODE 25130.7 <br /> A. EMERGENCY LEVELI/ II III PHS-E:H LOG T �9 ' 11 Q -- <br /> (Cif one) <br /> B. SOURCE OF NFORV[ATION <br /> Name: !7 �v-- uz't_=- Phone: 1 � �d- <br /> Company: <br /> Address: ,,a <br /> Designated Emnioyee Name: J Phone: <br /> Reporrmg Agency dame: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> � 1r J , — <br /> LocaIIOII: ` 5 �• V �"r <br /> (Best Physical Desc.-iru (City o o Circle One <br /> Date of Discharge: <br /> Date Notified: 3 3 c7 <br /> t D. RESPONSIBLE PERSONBUSIyi ESS <br /> Name of Business: C_ �!`u. ✓ �c�-s'rS <br /> Contact Person: r r' •` Phone: / � ) 3 4- i /I <br /> Phvsicai address: -7 5 i <br /> yfailing Address: +'' �=� x. yC,_r=r ter_ <br /> E. DESCRl MON <br /> Type of Discharge:Volume: <br /> Chemicals: <br /> Circumstances-, <br /> IA <br /> i 1 <br /> E ACTION TAKEN 7 U)A . _ ., <br /> (j`J <br /> SITE DISPOSITION <br />