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S. JOAQULY COLNTY tL E COPY <br /> YOTIF'IC_�.TIOY OF OF H.�ZaRDOL'S WASTE DISCS-f <br /> HE.XLTH & SAFETY CODE 3=130-7 <br /> A. EMERGENCY LEVEL Q M PIIS-Eli LOG If f O 3 <br /> (Circle one) <br /> B. SOURCE OF INFORMATION <br /> Mame: Phone: <br /> Company r <br /> Address: + <br /> Designated Empiovee`lame: Phone: <br /> Repomng Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCIKARGE <br /> Location: ID oO r7, �rrT/V�a_ " 11 <br /> (Best Physical Desc:ipao euvDfl County) Circle one <br /> Date of Discharge: <br /> Date Noticed: `t Time: <br /> D. RESPONSIBLE PERSON/BCS24ESS (�` <br /> Name of 3usiness: i V✓V �f k C ( 1 Zo-- <br /> Contact ?ePhonc-SF79 ;z 2- <br /> Phvsial address: J <br /> Mailing Aaaress: <br /> E. DESCRIPTION <br /> Type of Discharge: Le- <br /> Volume: <br /> Chemicals: <br /> Circums=ces: <br /> ST <br /> F. ACTION TAKEN SAS I <br /> SITE DISPOSITION A (,k a �� <br /> azfQ <br /> EA 22 0 L3 (Rev. 03;=0/93) <br />