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%W SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: Telephone: (MG )FSSa- 7550 <br /> Reporting Agency Name: <br /> Agency Contact: Telephone: <br /> Address: f,O. (- at c-c,f'�1, (-Az 915-1:210// <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: WyyLp; 0, / SoS <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: <br /> Date Notified: &,e., / r /??to Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business Na4_4 I <br /> Contact Person: Telephone: ji a In �, 3 yr <br /> Physical Address: Cf3 4753,Q) <br /> E. DESCRIPTION <br /> Type Release: <br /> /< �S c� <br /> Volume: / n T <br /> Chemicals: w <br /> F. ACTION TAKEN <br /> As 3V S �Q gid, �� a cva chi int, <br /> C ,C <br /> �iyl �clo6'��SS'DAF I ,�h�f l/Li �'-�-C' 4s'sC'ssf?2�irr�i' <br /> � f <br /> EH 2 013 (Rev. 02/90) <br />