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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE- <br /> HEALTH <br /> ISCHARGEHEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:CffI III <br /> PHS-EH LOG i <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> N <br /> arae: 141 ILE Phone: <br /> Company: o C s <br /> Address: <br /> Designated E�-aployer Name: Phone: <br /> Reporring Agency Name: <br /> Address: '01-,cleszse AL�-e <br /> C. LOCATION AND DATE OF 0ISC1-1AR E <br /> Locadon: ,- z, /a v �7 /�SSO� <br /> (Best Physical Desc-ir_ 'on) (City or o Circle One <br /> Date of Discharge: <br /> Da:e Notified: <br /> D. RESPONSIBLE PERSOIVlBUSULNE-SS <br /> ; Nane of Business- w'°�'� o. �' . <br /> Teieoho e: a1 9yB-9 Al" z— <br /> Conracr Person: � <br /> Physical Address: <br /> M 'ming Address: <br /> �. DESCRIPTION <br /> Type of Discharge: <br /> Volume: <br /> CnemicaLs: 9::: <br /> CirCIIII1SLanC�S � S Fit Ge.aS � r� r/r�c'� or .�f=L��ys1c .�41 O F � <br /> ACTION TAKEN( <br /> Si r DCSPOSITION <br /> C ,f <br /> EH 22 013 (Rear-4/91) <br />