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SAN JOAQUIN COUNTY ' <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE Q <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: <br /> (Circle One) II III PHS-EH LOG # <br /> B. SOURCE OF INFORMATION <br /> Original Source: �a�o / Telephone:) <br /> Reporting Agency Name: . Ina y c .�, /rc ,APs <br /> Agency Contact: _ Warn/ DL Telephone: <br /> Address: — /60/ f- zz, – <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 3536 e, Ctierokc, _ / < ,- -a <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: '-act -,Py <br /> Date Notified: 8- -22—,L7 Time: ///i." <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business <br /> Contact Person: 6i'oJ/Sec/ Telephone: (obi ) �S!k 9111,2— <br /> Physical <br /> y/ LPhysical Address: <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: tit, <br /> Chemicals: J- <br /> F. <br /> F. ACTION TAKEN <br /> /Pu,///e FiIE/CC�LY i�� L <br /> 7111�- <br /> _ c <br /> EH 22 03 (Rev. 7/89) <br />