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SAN JOAQUIN COUNTY �./ FILE COPY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEI/. I/ II III PHS-EH LOG <br /> cele one) <br /> B. SOURCE OF INFORLNIATION <br /> Name: <br /> Phone: ( ) <br /> Company: <br /> Address: <br /> Designated Employee Name: Phone: <br /> Reporting agency Name: v v <br /> Address: _ ( parr <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: -2 u fJ i� /D0J0 <br /> (Best Physical Nscription) V r County) Circle one <br /> Date of Discharge: <br /> Date Notified: 71sT Time: <br /> D. RESPONSIBLE PERSOWBUSINESS <br /> Name of Business: .v S 410- <br /> Contact Person: Phone: 93 7 <br /> Phv-sical Address: 2 <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: kCL�,1 ;5-r7aJ <br /> Volume. <br /> Chemicals: <br /> Circumstances: <br /> F. ACTION TAKEN 0� v <br /> SITE DISPOSITION <br /> EH 22 013 (Rev. 03/20/98) <br />