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SAN JOAQUIN COUNTY L E COP <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHA <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: (D II III PHS-EH LOG# v1— <br /> (Circle one) <br /> B. SOURCE OF INFORMATION <br /> Name: %EP4� C"'P'Q- Vq Phone: Orj%) <br /> Company:GQ. p " Se9-0 S\S <br /> Address\N\A SSC TcSCA\a�, �� `153aT> <br /> Designated Employee Name: Phone. <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location:(D\—X "3 <br /> (Best Physical Description) i r County) Circle one <br /> Date of Discharge: <br /> Date Notified: ocC. moo\ Time: \-;42, '�J Q <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: fz�2�b, \ C- <br /> Contact Person: L\\� SOyP Phone: <br /> CPI <br /> Phvsical Address: \�� ��T <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: 0� o°"\ ' <br /> Chemicals: <br /> Circumstances: <br /> F. ACTION TAKEN �Fc�� -Ca a '� <br /> SITE DISPOSITION <br /> EH 22 013 (Rev.08/20/98) <br />