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SAN JOAQUIN COUNTY <br /> NOTIFIC,`.t[ON OF HAZARDOUS WASTE DIS„�ARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL[I III PHS-EH LOG # 9 a <br /> ( ircle One) <br /> B. SOURCE OF [NFORMATI0 <br /> Name:__ke ti-f-7 c�-, �L S Phone: @ t/3 <br /> Company: <br /> Address: <br /> Designated Employee Name: S Phone: �f/t�..3y_3� <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: f9 19 E. Ci -) at j / SLS C <br /> (Best Physical Description) U or County) Circle One <br /> Date of Discharge: /_/wc�:'iN w <br /> Date Notified: —R—e� W-- 1?/ Time: 00 <br /> D. RESPONSIBLE PERSON/BUSINESS o <br /> Name of Business: R i G K`S TNfi LCLCit J <br /> Contact Person: -ITc ti .h r LD vwCuc-L� Telephone: go — F?0.1 <br /> Physical Address: <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: �cr� � <br /> Volume: L <br /> Chemicals: <br /> Circumstanc : a w y. <br /> F. ACTION TAKEN P L- `cyU <br /> /9' G t/J/ <br /> O <br /> SITE DISPOSITION +wLzT <br /> EH 22 013 (Rev.4/91) <br />