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I <br /> "' SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I I III PHS-EH LOG # <br /> ( ircle One) <br /> B. SOURCE OF INFORMATION <br /> Name: 4 , ; 61- rA Phone: -Av5S0 <br /> Company: 14t;,,L,/s.1 <br /> Address: 73- 7 F, fa .S/ 7"-u c c, C!l 983�d <br /> Designated Employee Name: 0'e"o/ o i Phone: 22: V 8-3 Y` t, <br /> Reporting Agency Name:—'a :,�a2u%n /1141i 11e Afl S&, .,cPs <br /> Address: vvr lu, S c k c v. e cavi <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 75"7 �7. // 2�4 S-1- <br /> (Best Physical Description) (City or County) Circle One <br /> Date of Discharge: -ill � <br /> Date Notified: 7,1,-/F Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: = ys,4 <br /> Contact Person: o er Fk a z Telephone: (_?yj ag 6 /bs-o <br /> Physical Address: ,- <br /> S/- <br /> Mailing Address: S -.._e <br /> E. DESCRIPTION <br /> Type of Discharge: una&t-f<iu-, zec/ <br /> Volume: /co - <br /> Chemicals, A �Gzual« / <br /> Circumstances oV <br /> F. ACTION TAKEN oil in oa,,av) %+ 1nrn1 a11 /vUdw/, ; a.us Za ?e^- cl /s <br /> _(,/aS.�- ('Ji/ r" .Cc.�� ,SRw�er �s �:� •,/vv) /�.. Cc% �esu cv (/f(! K[ctnr✓ <br /> cam. <br /> SITE DISPOSITION <br /> EH 22 013 (Rev.4/91) <br />