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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE / <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: 11 III PHS-EH LOG # / -��� <br /> ( ircle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Sltu— - 1p- Phone: L� <br /> Company: KPz Q <br /> Address: <br /> Designated Employee Name: U Phone: Lj <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: oZ l S ! C,0,1- <br /> (Best <br /> w H- .(0i , r(Best Physical Descrip n) (City or oun Circle One <br /> Date of Discharge: i Ln�2�we ✓�^ <br /> Date Notified: 1 - lR- i Time: /o :30 a ave <br /> D. RESPONSIBLE PERSO BUS NESS <br /> Name of Business: u =c. <br /> Contact Person: Telephone: <br /> Physical Address: <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: v -12 <br /> Volume: �ruZJ y. <br /> Chemicals• ��> e <br /> Circumstances: <br /> F. ACTION TAKEN Gfir lnA�t�� rc� +2I?�/l lint ltz�2� <br /> SITE DISPOSITION (/AP <br /> EH 22 013 (Rev.4/91) <br />