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SAN JOAQUIN COUNTY A <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE HEALTH & SAFETY CODE 25180 .7 <br /> UG <br /> A. EMERGENCY LEVEL: II III HEALTH DISTRICT LOG # �/ � U <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: teoA/ &C)jj?,e(S Telephone: ( <br /> Reporting Agency Name: 5Aa2/ , ZQAQU/,CJ 0CNf Ake- <br /> Agency Contact: Telephone: O 3�122-- <br /> Address: /f C3 .ne �/ �5y, Cf�h. <br /> C. LOCATION AND DATE OF DISCHARGE <br /> n <br /> Location: <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: om, ---4z�/iti/ <br /> Date Notified: �/�6/�'y Time: 9 DO <br /> D. RESPONSIBLE PERSON/BUSINNESS /� <br /> Name of Business A19 /Ae 7 <br /> /'7 <br /> Contact Person: �OYLi mez Telephone: ( ) 2- /z66 <br /> CF <br /> Physical Address: <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: <br /> Chemicals: <br /> F. ACTION TAKEN <br /> 1_�1 <br />