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SAN JOAQUIN COUNTY ftf <br /> NOTIFICATION OF HAZARDOUS WASTE DISCH--kRGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL�d II III PHS-EH LOG <br /> (Circle one) <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: ( ) <br /> Company: <br /> Address: <br /> Designated Emplovee dame: Phone: <br /> Reporting Agency Name: <br /> Address Lr /.�L�wr ��y <br /> C. LOCATION AND DATE OF DISCH_-kRGE _� � <br /> Location:V70 `7 s ✓+7 J&- <br /> (Best Physical Description) rca or Count%) Circle one <br /> Date of Discharge: l M-4,4jv <br /> Date Notified: Time: /U=do A- <br /> D. RESPONSIBLE PERSB`ONUSNFSS'., J <br /> Name of Business:n/ <br /> �J�^ <br /> Contact Person: r P / iMu i n Phone: Zd iT 6/ <br /> Ph%sical address: s(7o7 .�Q <br /> Mailing Address: <br /> E. DESCRIPTION <br /> T%-pe of Discharge: <br /> Volume: t^tiL� <br /> Chemicals: �rG <br /> Circumstances: I1 <br /> F. ACTION TAKEN <br /> SITE DISPOSITION Pm C�+wt <br /> EH 22 Ola (Rev. 03!20/98) <br />