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SAN JOAQUIN COUNTY �- <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVELO II III PHS-EH LOG # mo <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: Telephone: <br /> Reporting Agency Nam • :f�S- <br /> Agency Contact: Telephone: 7 <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: -//� e � �/ <br /> (Best Physical Description) (City or County <br /> Date of Discharge: - 2-/9�5L1 <br /> Date Notified: :�F--/9 -$2 Time: - --12-: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business <br /> Contact Person: Telephone: 212-2/5f <br /> Physical Address: <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: <br /> Z <br /> Chemicals: <br /> F. ACT ON TAKEN <br /> EH 220 e . 7 �� ' <br />