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A. <br />C. <br />I� <br />E. <br />F. <br />✓SAN JOAQUIN COUNTY <br />NOTIFICATION OF HAZARDOUS WASTE DISCHARGE (J M <br />HEALTH & SAFETY CODE 25180.7 U <br />EMERGENCY LEVELO II III <br />(Circle One) <br />SOURCE OF INFORMATION <br />PHS -EH LOG <br />Phone: <br />nucucao. v ,•.- . — - - - - - - - <br />Designated Employee Name: r' ca Phone: (2oj 'I <br />Reporting Agency Name: Gn, <br />Address: vvS A2S :7-0 u.;; S <br />LOCATION AND DATE OF DISCHARGE <br />Location: FO() W CL ,� / <br />(Best Physical Description) <br />Date of Discharge: -z A- 3 <br />Date Notified: /93 Time: - <br />Cary o County) Circle One <br />RESPONSIBLE PERSON/BUSINESS <br />Name of Business: ii/i >��l SSP. �u PG�locuc0 Co " <br />Contact Person: Ali Telephone: (ate) fG d, - s> s/ <br />Physical Address:v <br />Mailing Address: <br />DESCRIPTION <br />Type of Discharge:-- <br />SITE DISPOSITION <br />(5D <br />EH 22 013 (Rev.4/91) <br />