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r <br /> SAN JOAQUIN COUNTY V�- <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE r <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL1 /II III / PHS-EH LOG # 2-DSD <br /> (Acle One) <br /> B. SOURCE OF INFORMATION <br /> Name: C korlp,. //, Phone. 9 aG_ :e ,_ <br /> Company: T.J of- - Cwl? <br /> Address: Po. <'-fx k`nL r4 9S <br /> Designated Employee Name: Char%a Ni,. Phone: (rai ) '1x:7- 791yo <br /> Reporting Agency Name: c. Pf/ -Eula <br /> Address: P(N. 3:,,: .;Z ooh S-CO- k >U r,7 `)57�zC j <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: FF-ewe�f -�t <br /> (Best Physical Description) (City or County) Circle One <br /> Date of Discharge: !Ivk;+,owe% <br /> Date Notified: c /,-Y Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: R Ajeye, T"rec <br /> Contact Person: . Telephone: O"r Sroo <br /> Physical Address: --5�7 F. F � o-F �t 5 �k�N <br /> Mailing Address: R. r . -Rex <br /> E. DESCRIPTION <br /> Type of Discharge: Ug7z- <br /> Volume: <br /> Chemicals: e/ -r'.e ! <br /> Circumstances: u } T 4,7, <br /> J <br /> F. ACTION TAKEN 41( /yx k3,� ,6Qrfy7e# <br /> SITE DISPOSITION / R <br /> L'cm Get � i? v-` -H�s Rfi f C. -fo �•,�. �' c,�7uN <br /> -Fip <br /> EH 22 013 (Rev.4/91) <br />