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SAN JOAQ[tilr COLNTY V.001 <br /> NOTIFICATION OF a kZARDOUS WASTE DISCHARGE FILE C C 7 Y <br /> HEALTH & SAFETY CODE 25180.7 p <br /> A. E'YIERGENCY LEVEL: I [I [II PHS-EH LOG r 1 2 <br /> (Circle one) <br /> B. SOURCE OF [NFOR.VIATION <br /> Name: 'adyll aOa� �Oh � R/Phone: ( � hbla7 — / 66& <br /> Company: <br /> Address: <br /> Designated Emplovee Name: Phone: O — <br /> 7-3 <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION .-lu D DATE OF DISCHARGE <br /> Location: 3 33 /l1 A d, 4 r t R oL ! S G <br /> (Best Physical Description) (City o ounty Circle one <br /> Date of Discharge: <br /> Date Notified: — Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> 10 <br /> dame of Business: <br /> /4- P S <br /> Contact Person: 13 j S Gh U YJ Phone: <br /> Physical Address: (- <br /> Mailing .address: D. <br /> E. DESCRIPTION �n7 <br /> Type of Discharge: GriA K Enr3 m. u^S T <br /> Volume: <br /> Chemicals: <br /> Circumstances: <br /> Q� <br /> S n <br /> W i P i ✓t� C�ev �i rh *✓J, <br /> F. ACTION TAKEN <br /> SITE DISPOS ON <br /> c <br /> e <br /> EH 22 0 t= (Rev. 03/"20/98) <br />