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- .AN JOAQUIN COUNTY �-- <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 COPY <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG # / z/— G <br /> (Circle One) <br /> B. SOURCE OF INFORMATION (Z� �� 'yy2� <br /> Name: PA-vi L �/ /a- Phone: <br /> Company: o <br /> Address: L9-0 /> T� <br /> Designated Employee Name: - 2. S .n v Phone: Vj) <br /> Reporting Agency Name: v 27 6Ie� <br /> Address: <br /> C. LOCATION AND DATE OF/DISCHARGE <br /> Location: 10 W, NT l-vn/'G / <br /> (Best Physical Description) (City or Co ) Circle One <br /> Date of Discharge: .✓ CH <br /> Date Notified: Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business <br /> Contact Person: Telephone: (2Q6h — T� <br /> Physical Address: T/zA= A6 Z- L/5. Zy=� t.p <br /> Mailing Address: 9 :7-4- <br /> E. <br /> 4E. DESCRIPTION <br /> Type of Discharge: V <br /> Volume: //✓/�wvz✓* __ / <br /> Chemicals: vww-- r`,, cit 16 rJS v w <br /> Circumstances: / Fav vv / Rd Y — <br /> F. ACTION TAKEN — Uv, dZ, ✓b w� s�/ � �CS <br /> r&,t,x,ava o ,.! i,9- Z8 3 <br /> SITE DISPOSITIOCIesr: K <br /> Y� i n w� r� a.-- <br /> w. <br /> &ap r 6a <br /> EH 22 013 (Rev.4/91) <br />