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-/-t CQ <br />SAN JOAQUIN COUNTY <br />NOTIFICATION OF HAZARDOUS WASTE DISCHALOP <br />HEALTH & SAFETY CODE 25180.7 <br />A. EMERGENCY LEVE II IIIPHS-EII LOG # <br />D <br />(Circle One) <br />B. SOURCE OF INFORMATION <br />Original Source: rn5- , t Telephone: <br />Reporting Agency Name: Sq, L bwgl, <br />C. <br />D. <br />Agency Contact: CA /os ///,,,,/�I, <br />Address:- IeO(C- i/n24,&Ar / ,d,)� <br />LOCATION AND DATE OF DISCHARGE <br />Telephone: :O q6Y'-:31�yp <br />Location: 8 � 3 C <br />(Best Physical Description) (City or County) <br />We of Discharge: GAS <br />Date Notified: <br />RESPONSIBLE PERSON/BUSINESS <br />Name of Business_ %>.c, <br />Time: <br />Contact Person: <br />Telephone: Zr s <br />Physical Address: <br />E. DESCRIPTION <br />Type Release: _ <br />Volume: <br />Chemicals: n,P <br />F. ACTION TAKEN <br />w <br />EH 22 03 (Rev. 7/89) <br />