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1 . SAN JOAQUIN COUNTY '.. O Dy <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGEC 1Ur U <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: III PHS-EH LOG # 6 S S <br /> (Circle One) <br /> B. SOURCE OF INFORMA ON <br /> Name: G10✓icD Z3vo � Phone: (y&k <br /> Company: Crt dnEb. c <br /> Address: i 7h� ��r Go er �✓� S Go 9to 3 <br /> Designated Employee Name: Phone: (�) <br /> Reporting Agency Name: <br /> Address: SoW c'. AuF sate- G9 <br /> C. LOCATION AND DA E OF DISCHARGE <br /> Location: Z/3 3w- 14,f- V / SCJ <br /> (Best Physical D sc 'ption (City or !un ' cle One <br /> Date of Discharge: v OW <br /> Date Notified: �11/f Time: Z -' o <br /> D. RESPONSIBLE PERSON/ USINESS <br /> Name of Business: { u, (-2> <br /> Contact Person: 6- e r,-e- Telephone: 7 — 6 <br /> Physical Address: '2' Z6 nl c,-5 so -r li n't/a a f, <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Disch ge• <br /> Volume: <br /> Chemicals: rvd c ,- d <br /> Circumstances: or — o o7TE a <br /> /'v Iry.c.r.YJ Tia <br /> F. ACTION TAKEN sr , ,S <br /> SITE DISPOSITION s r AE o 'er S l� <br /> � <br /> e.4 i 'r 1q1q zec <br /> EH 22 013 (Rev.4/91) <br />