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—� SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE D[SCHUVFIY <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: 0 II III PHS-EH LOG # 79 <br /> (Circle One) <br /> 3. SOURCE OF INFORMATIONas <br /> phone: (Z ) Y66 96�� <br /> Name: <br /> Company: <br /> Address: &(F 6 5 '- <br /> Designated Employee N Phone. (_) <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATTF OF DISCHARGE / e OC611 <br /> Location' S � �^�4 <br /> (Best Physical scription) Ciry or County) Circle One <br /> Date of Discharge: <br /> Date Notified: 0 Time: 9 <br /> D. RESPONSIBLE PERSO BUSI SS <br /> Name of Business: <br /> Contact Person: �G^� my Telephone: <br /> Physical Address: S S 64 2& <br /> Mailing Address: 020 SZo <br /> E. DESCRIPTION <br /> Type of Discharge: Lily <br /> Volume: �7l vu^^ <br /> Chemicals: <br /> Circumstances: <br /> W c <br /> F. ACTION TAKEN <br /> W � <br /> SITE STATUS <br /> EH 22 013 (Rev.4/91) <br />