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1%w <br />... <br />SAN JOAQUIN COUNTY ` �>� L E COPY <br />NOTIFICATIONHAZARDOUS <br />TH & AFTY CODE 25180.7SCfIAR <br />A. EMERGENCY LEVEL: I II III <br />PHS -EH LOG R O I — Ovtil <br />(Circle one) <br />B. SOURCE OF INFORMATION <br />io A,.ri_ .. _Phone:'Iw µ✓a7 <br />Company:_ 0 <br />Address: <br />Designated Emplo <br />Reporting Agency <br />C. LOCATION AND DATE OF DISCHARGE <br />E- <br />F. <br />(Best Ph ical llescnpn <br />Date of Discharge: <br />Date Notified: <br />RESPONSIBLE PERSOWBUSINESS <br />Name of <br />Contact <br />Physical <br />Mailing <br />DESCRIPTION <br />Type of Discharge: -40 <br />rAM <br />one <br />EH 22 013 (Rev. 08/20/98) <br />