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:r <br /> SAN J'OAQUIN COUNTY <br /> NOT <br /> IFICATION <br /> OF HAZAR.DOUSMASTE DISL RGE <br /> I-IFALTH & SAFETY CODE 25180.7 <br /> C. l : # _ <br /> A. EMERGENCY LEVEL;g II iiI <br /> � PS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION . 3. . +3,4 <br /> Name: `Y . n� Z�1G Phone: CZE <br /> Company: l <br /> " a <br /> Address: Z C Z-E ' 1 S" 6 <br /> Designated Employee Name:^ Phone: (z� JGss-? <br /> Reporting Agency Name: 57c7�. TD 1C� c� <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> E Location: Z 11 b7 Al <br /> (Best Physical Description) r (City or E2OiFy) Circle One <br /> Date of Discharge: nl�Na w <br /> Date Notified: 7 Z � Time: . 4 =Dv a :F <br /> D. RESPONSIBLE PERSON/BUSINESS ► <br /> Name of Business: -d -r4 <br /> Contact Person: Telephone:`(_,,j <br /> Physical Address: 12 <br /> Mailing Address: tzZ,b-7 16�-rzzf Aa S7v��TDeJ �SZo <br /> r <br /> E. DESCRIPTION <br /> Type of Discharge: r7roAI -r-C,4 IL ✓�-Q-2�.e R _ <br /> Volume: ^I r`!o W Kl _ <br /> ` Chemicals: aa. <br /> Circumstances: 14!5vq�� a r yj,16oA4�n,4 o a;-rA,(ruCD12,AIIJ - _-- <br /> 7yF nla �,4vvhl sr� nlorca �`c1.�ria><l_ <br /> F. ACTION TAKEN 4 <br /> SITE DISPOSITION r��Vc7F�6� c7 yam-».� .�� -rc3ft �� +-z���`�cx� �•.«i -- <br /> ���v�c+Em�7 ?v <br /> /3,1— 13 p- 0;4/ 4,eV D GZR G U.Q c✓ QG L3 - _ - <br /> EH 22 013 (Rev.4/91) - <br /> F - <br /> 1 <br />