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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:,III III <br /> Circle One) r U <br /> B. SOURCE OF INFORMATION U <br /> Name: Phone: <br /> Company Pp�w0 <br /> Address: Q Zo5 Ykvw u2 �9sT--11t 4539 <br /> Designated Employee Name: Pone: 2 <br /> Reporting Agency Name: - k <br /> Address: ��2 <br /> C. LOCATIOND DATE F DISCHARGE <br /> Location: 404 0. 4AUkxi' / <br /> (Best Physical Description) Ci or County) Circle One <br /> Date of Discharge: Lik <br /> Date Notified: ll-1 - Time: <br /> D. RESPONSIBLE PERS N/BUSIN SS <br /> Name of Business: <br /> Contact Person: Telephone: - <br /> Physical Address: 95 91 <br /> Mailing Address: wan, CA <br /> E. DESCRIPTION <br /> Type of Dischar e: <br /> Volume <br /> Chemicals: i E 3-A-0 <br /> Circ tances <br /> F. ACTION TAKEN dCr1ct <br /> l 1 <br /> SITE DISPOSITION <br /> 4D de4t�xt—4-L <br /> EH 22 013 (Rev.4/91) <br />