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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> copy <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:0II III PHS-EH LOG # — <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: JEZRY yo-SkkOKA Phone: (2C t)1{108 0�3s <br /> Company:_. <br /> Address: _ <br /> Designated Employee Name:_Jury �( Phone: ?o9 <br /> Reporting Agency Name:1-S1�ar .ba <br /> c. 6, <br /> Address: 30.4 C NG qtr 4,r <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location:_ 1325 Car,-al �Aol(ow / 'Trgcy <br /> (Best Physical Description) (City or County) Circle One <br /> Date of Discharge: Ur\krncmw\ <br /> Date Notified: Juno l% qq-+ Time: Il05(o he rg <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: Tex <br /> Contact Person: Kr,14 bbrnC, Telephone: <br /> Physical Address: <br /> p )�s9-z89� <br /> Mailing Address: _?�, 8oX lode d1a, o C-A 44 O <br /> E. DESCRIPTION <br /> Type of Discharge: Urak-44,oK \ud <br /> Volume: hlk, owe <br /> Chemicals: „ <br /> Circumstances: L-t d� - rte y ` --- <br /> Cc�rF'nn+ <br /> F. ACTION TAKEN Two un b1v s t or p ks <br /> SITE, STATUS <br /> � M FI? .-c. � nrnOlc.�Y d�nFLier r� ts- cs,n�u <br /> cFN,:�ACk-- nr+ton <br /> EH 22 013 (Rev.4/91) <br />