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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: 11/ II III PHS-EH LOG # — — S <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: 1 c (NO C_ Telephone: C� <br /> Reporting Agency Name; A -Sfzz <br /> t/K 5 <br /> Agency Contact: A/u nl A �Je A—O Telephone: (� ?-3,fa c? <br /> Address -aLl %S'?A9 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: /�l f, r�✓/C Gr'hsf Cry _ J72L7d <br /> (Best Physical Description) <br /> (City or County) <br /> Date of Discharge: <br /> Date Notified: _/i <br /> Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business OOG <br /> Contact Person: N Telephone: <br /> Physical Address: /�C .�%,��//C G✓esf Cin c/P f 7ud �� <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: U/1//1iv«�✓ <br /> Chemicals: ro/moi, a �i yam%o 6os <br /> F. ACTION TAKEN <br /> Me <br /> ry u� �/ sfi��� �d �i4r✓L� r <br /> G <br /> -�L L <br /> EH 22 03 (Rev. 7/89) <br />