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. - COP <br /> COUNTY <br /> SA1N JOAQUIN. <br /> HU <br /> NOTIFXC.�TION OF HAZ RD US WASTE CODE 25180.'7SCHAI�GE <br /> HEALTH & SAFETY <br /> L.//I II III PHS-EH LOU f d� 6-6 <br /> A. EMERGENCY LEVE (cirL(1) <br /> one) <br /> B. SOURCE OF INFORMATION IPA <br /> Phone: (LI 1 <br /> Name: V� <br /> Company: 6[, �") (fir b <br /> Address: 0 LI D • e ` r.�-U Phone: Zo 6 <br /> Designated Employee Name: M�.+fJ �- <br /> � <br /> Reporting Agency Name: S <br /> Address: D lnl <br /> h <br /> • � i <br /> C.- LOCATION AND DATE OF DISCHARGE � � nor � • <br /> County) Circle one <br /> Location: <br /> (Best Physical Des�cri tion) <br /> Date of Discharge: 2 Time: 3:3l7 <br /> Date Notified: <br /> I <br /> D RESPONSIBLE PERSON/BUSNESS <br /> rn 4a - <br /> 22 <br /> Name of Business: Phone: BD <br /> 'Person: DContact <br /> Physical Address: <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: f 4r} <br /> Volume: r+- ttc�''S • o C./3 <br /> Chemicals: �✓� 2 w el i" s ' <br /> Circumstances: <br /> re Uws v ern <br /> - i.Ul • r <br /> F. ACTION`I'AKEN Com. 'k �• C/'�-� C� �°''�'ef� <br /> S M Y <br /> SITE <br /> DISPOSITION C �� <br /> EH 22 013 (Rev. 08120198) <br />