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C <br /> SAN JOAQUIN COUNTY ... <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: II III PHS-EH LOG # 93'05. <br /> ( c1e One) <br /> B. SOURCE OF INFORMATION <br /> Name: %1i al".a s /{mz;-S Phone: <br /> Company: A/v7/ye-. / <br /> Address: f Y1 O 2:76 <br /> Designated Employee Name: Phone: MeZI S 605t <br /> Reporting Agency Name: S,*IV Co If*A- Feces— r-- <br /> Address: <br /> Address: , o . A aX� : i O o�-ro.✓ �- 9 SZCJ/ <br /> C. LOCATION AND DATE OF gISCHAP <br /> Location: f (a l S W 1 1 K <br /> (Best Physical pescription) (City or C ty) Circle One <br /> Date of Discharge: L/i✓X�i ar,v <br /> Date Notified: ?, Time: aO /.-M <br /> D. RESPONSIBLE PERSON/BUSINESS / <br /> Name of Business: 6 N -S nes-F <br /> Contact Person: Tiw d as n/n.�%� S Telephone: S/ ��_� C/ 0 <br /> Physical Address: 6 <br /> Mailing Address: 181r) <br /> E. DESCRIPTION <br /> Type of Disc{�arge: U <br /> Volume: CIN 1CvL,0vj -j <br /> Chemicals: o r4 <br /> Circumstances: 542 azo v, SP�z-dict <br /> (J(rST <br /> F. ACTION TAKEN W /'2 m,*v,%-o✓ec1 o i✓ 2-7 3 , <br /> SITE DISPOSITION b e- <br /> Nl ,2 S f b <br /> P PA <br /> EH 22 013 (Rev.4/91) <br />