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SAN JOAQUIN COUNTY Cr <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 O <br /> A. EMERGENCY LEVEL:p II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATIONN n <br /> Original Source: I Q 71'h`R. f'�eSC� Telephone: (�Q1) Y-io?— <br /> Reporting Agency Name: S - p4: GL4 w en <br /> Agency Contact: et/rwia `j 1/ Telephone: () 4%3Yao <br /> Address: P. 0 — a d 2 9Sa O / <br /> C. LOCATION AND DATE OF DISCHARGE L <br /> Location: -3 S-3 5 <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: / <br /> Date Notified: Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business ^ , ,1LS0-16?10� <br /> Contact Person: _ke,4� Telephone: (a(79 ) 4/60 2lc/�o Z <br /> Physical Address: P � �0�� �t C� �/ a D <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: <br /> Chemicals: /y <br /> F. ACTION TAKEN <br /> /, A?9 <br /> Q � <br /> EI-I 22 03 (Rev. 7/89) �e 7 <br /> i <br />