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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: Q"7ft III PHS-EH LOG # qy_/ / 0 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION 99 <br /> Name: 40?4z rTP.E17 1 Phone: C!E5.) NZ o3S y <br /> Company: <br /> Address: <br /> Designated Employee Name: Phone: (_ ) <br /> Reporting Agency Name: <br /> Address: 3-c-al ,E. �v6f�Fi4�E. .� rt �i STS G4 �34zo i <br /> C. LOCATION AND DATE OV DISCHARGE <br /> Location: Z:ac- Gb.AZ <br /> (Best Physical D�sc�t�ptiop) Q� County) Circle One <br /> Date of Discharge: vnik�lo " <br /> Date Notified: Time: -t <br /> D. RESPONSIBLE PERSON/BUSINE S <br /> Name of Business: /,Jle, I flecP 7i <br /> Contact Person: .may � 1d 5.,r-,j Telephone: <br /> Physical Address: 7_1Q7 ate, Gopi ,qvf. /—aoi �4 9SL�o <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge. <br /> volume <br /> Chemicals: E <br /> Circumstances: v <br /> s r--- Sar m <br /> F. ACTION TAKENy�<GCLr S qG�i�r1�ti4S 4fi'7� <br /> SITE DISPOSITION Fv�-sJse s7z.� �gdsG s5�, It—�7cwu. P�v �,e <br /> rT➢' DF.s-TF�i�+.� F rrAJ.� 5V^ =,11--1 1-2 /A4TYO <br /> EH 22 013 (Rev.4/91) <br />