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aw SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISC F-1ARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: V II III PHS-EH LOG # 1 3 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: /ems Phone: (2,99 8"_;?So 7 <br /> Company:// fii � �e..O �aPISj2o �A�fn T�c�t Ce��p <br /> Address: 17! ,) t1t <br /> Designated Employee Name: Phone: L� <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: // . u .LY " lea( <br /> (Best Physical De cription) (City or Circle One <br /> Date of Discharge: <br /> Date Notified: /D - 7- 11 Time: /-'09,82n <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: <br /> Contact Person: ,!(s. yyowHe l�ajree— Telephone: <br /> Physical Address: <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: -44-Ak <br /> Chemicals: <br /> Circumstances: e <br /> ii/iD� Q�Q7�ert /a�( (/6 sT aav <br /> F. ACTION TAKEN <br /> eco s�i el, <br /> ter— <br /> SITE DISPOSITION <br /> EH 22 013 (Rev.4/91) <br />