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f SAN JOAQUIN COUNTY (a a <br /> Py <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE 'u(_' <br /> HEALTH & SAFETY CODE 25180.7 <br /> L� Qn <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Jim Ff, ro Phone: (Z 83 :447? <br /> Company: <br /> Address: 1= <br /> Designated tmployee Name. Phone: 009) 2 <br /> Reporting Agency Name: i N — I <br /> Address: S Or.) <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: t1Srl E. J ( f-c, 5T. le tkz -, CA- / CI S3 6 <br /> (Best Physical Desorption) Ci r County) Circle One <br /> Date of Discharge: Lj rJ <br /> Date Notified: Time: G <br /> D. RESPONSIBLE PERSON/BUSINE S <br /> Name of Business: (0 (Or2.P <br /> Contact Person: �Zb �r„� 1AZl�iIZ Telephone: <br /> Physical Address: <br /> Mailing Address: <br /> E. DESCRIPTION 7 <br /> Type of Discharge: ��t&y-,n LAJ <br /> Volume: aQ nl <br /> Chemicals: BO Q r <br /> Circumstances: g= 'Skmk2L6, e, O 0r(— <br /> F. ACTION TAKEN h1 cQl�f ei U e� <br /> r.1 k WAS . YL I,u c .j e l n A/ f 7— .bT <br /> SITE DISPOSITION P r S e ia- <br /> rp,m LA <br /> ljre.,A r <br /> 0 <br /> EH 22 013 (Rev.4/91) <br />