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T <br /> �./ <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:011rcle <br /> II III PHS-EH LOG # <br /> ( One) <br /> B. SOURCE OF INFORMATION �� 3 <br /> Name: IA.J,4 n/14 Phone: ( � <br /> Company: Iu CoR 77/ SES✓ <br /> Address: k �o�4�yin/ t �✓ �LO� <br /> Designated Employee Name: Phone: (� <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION 3 6F �� / <br /> Location: <br /> (Best PhysicalD scrip 'on) r County) Circle One <br /> Date of Discharge: f kgs tt <br /> Date Notified: /a5 Time: 1.3 30 <br /> D. RESPONSIBLE PERSON/j3USINESS -� <br /> Name of Business: (-9k p ✓Luc �eux� <br /> Contact Person: Telephone: La 7 <br /> Physical Address: �✓3S E• n� 42=:fy SY,4- - t— <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: S <br /> Chemicals: <br /> Circumstances: <br /> F. ACTION TAKEN ���c « z�+�tzcp /Q� CLQ Q �'✓ lz/�(a <br /> Guz 94n K b,b <br /> GL r( dhiC2ce�a 7�-- k D <br /> SITE STATUS <br /> /G Com. <-&'� <br /> v A o EH 22 013 (Rev.4/91) <br />