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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL/ I/II [II PHS-EH LOG <br /> Cl'rcle One) <br /> B. SOURCE OF NFORM�TIO ��� <br /> Name: I1 !� Phone: cot 38-3. <br /> Company: L <br /> Address: C 9 3 <br /> Designated Employee Name: Phone: 02 ) 4(O8 -03 <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHAR E / <br /> Location: ! 530 'A EI qhs' A til / GKfa� <br /> (Best Physical D cription) (City oounty Circle One <br /> Date of Discharge: U/✓1 eiv6 <br /> Date Notified: Z Time: 2;UD <br /> D. RESPONSIBLE PERSQN/BUSINESS <br /> Name of Business: e'brWt.C, H CN� <br /> Contact Person: V Ghr Q_ Telephone: <br /> Physical Address: l l S�3(D W• L jZT id• 5-ItQe-Far `1 SZICI <br /> Mailing Address: SG�v�✓-- <br /> E. DESCRIPTION <br /> Type of Discharge: 16a K <br /> Volume• <br /> Chemicals: <br /> turns antes: <br /> F. ACTION TAKEN �/Y/✓l6C /l/W�6Va� / 4u1 C <br /> SI p$ 1?ISPOSITION 057yn/I, loin LU i! W <br /> i' if f 2.C�LceC �o <br /> r <br /> cv <br /> EH 22 013 (Rev.4/91) <br />