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SAN JOAQUIN COUNTY <br /> NOThv<CATION OF HAZARDOUS WASTZ-14ISCELARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> 1 <br /> A. EMERGENCY LEVEL II III PISS_EH LOG-� <br /> (Circlz one) <br /> B. SOURCE OF INFORMATION / <br /> Marne: ��sp �� Phone:{tel <br /> Company: r <br /> Address: <br /> Designated Employer Name- Phone: ' <br /> Reporting Agency Nanne: <br /> Address: -raV f4- <br /> C. LOCATION AND DATE OF DISCHARGE l/ <br /> Location: —:2fG33 <br /> (Best Physical. Description) (( ty ounrv) Circle one <br /> Date of Discharge: <br /> Date Notified: Time: /�= �' _ <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: lay �/r �'b` <br /> Contact Person: Phone: l- "!/ <br /> Phvsical Address: <br /> ailingAddress: <br /> E. DESCRIPTION / <br /> Type of Dischame: &—ezG «1 <br /> Volume: <br /> Chemicals: - H <br /> Circumstances: r l' lJS: lv— <br /> F. ACTION TAKEN <br /> SITE DISPOSITION % Z, e—"z <br /> EH 22013 (Rev. 03f1_0193) <br />