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SAN JOAQULN COUNTYIN <br /> NOTIFICATION OF HAZARDOUS WASTE DIscE41L E COPY <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVELI III PHS-EH LOG 41 Ooh - 014- <br /> Qc1le <br /> one) <br /> B. SOURCE OF INFORMATION /o <br /> Name: ( � L Phone: (7)q 71-7 1- <br /> Company: <br /> Address: U ci f $to e <br /> Designated Employee dame: Phone: <br /> Reporting Agency Name: �/rn CP��Igt" fit1lhFanrAa,.6-Q � 0e(2It, ot— <br /> Address: r?a$q f, be)4 ..�_ kvr2 <br /> C. LOCATION AND DATE <br /> ��O�'F DISCH.aRGE <br /> Location:' (,Q K q (A Q L -t-c' <br /> (Best Physical Description) i •• r County) Circle one <br /> Date of Discharge: b -y-y ev^-- <br /> Date Notified: (-k Timer, <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: Ll-� LI VA <br /> Contact Person: C-[ - AIV-� W Phone: <br /> Physical Address: j! A til GO .n-E- J[JA;�It a <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: t S�xl(�vLeuS.� <br /> Chemicals: fvl Q, i: `y'6h <br /> Circumstances: io;AAje,� <br /> F. ACTION T.aKEN r rfe -JM tAC Q cg :4L..l_&-FAVcni& <br /> SITE DISPOSITIOND <br /> EH 22 013 (Rey. 08/20/98) <br />