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's SAN JOAQUIN COUNTY <br /> '<..t NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> a HEALTH 6 SAFETY CODE 25180. 7 <br /> A• EMERGENCY LEVEL: II III <br /> (Circle One) HEALTH DISTRICT LOG <br /> B. SOURCE OF INFORMATION <br /> Original Source: I��. ATelephone: ( ) 2gyp <br /> Reporting Agency Name: <br /> Agency Contact: �S <br /> 'I •• Telephone: <br /> Address: <br /> r C. LOCATION AND DATE OF DISCHARGE <br /> Location: <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: —ut-KNOW�J - <br /> Date Notified: ll�i �3Q,� <br /> � Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business �T � V41liR�n <br /> Contact Person: Telephone: ('� ) <br /> Physical Address : T j( d <br /> a,i - <br /> e� E. DESCRIPTION n <br /> Type Release: JJL) kU-R+t�f,lI - rifrrt� r{k311t f�gPT ri4RV6^ I k <br /> Volume: <br /> LLOfJ S <br /> Chemicals : <br /> F. ACTION TAKEN A <br /> C--Ul Fi Si <br /> '� X71 lRc�kZUSx� 1S �CIN(n YI(Yt��� � 'TthS `(tYll�. �.0 Tb Q;tQBf�i r`1/P <br /> R�9�I�,uC�•�-�s O'F ,SUS 2�. - , . . - <br />