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C <br /> r' <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180 .7 <br /> A. EMERGENCY LEVEL: II III HEALTH DISTRICT LOG <br /> (Circle One) 0 <br /> B. SOURCE OF INFORMATIIO'N / <br /> Original Source: Telephone: <br /> Reporting Agency Name: Lsl <br /> Agency Contact: ��9Lhc/ CJC�%.(��« Telephone: �'�/) {�'� jY�J <br /> Address: M)61 <br /> C. LOCATION ANDDATEOF DISCHARGE <br /> Location: <br /> (Best Physical Description ) (City or (. only ) <br /> Date of Discharge: .:moi <br /> Date Notified: l Time: _T: FYN,-' <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business <br /> Contact Person: 4A(.y-L Telephone: <br /> Physical Address : L� 3 <br /> E. DESCRIPTION <br /> Type Release: hl/,,7 <br /> Volume: l.4-�/l ' <br /> Chemicals : Gz -"v/ 4Be6e/ <br /> F. ACTION TAKEN <br /> v�T f9/r7� O C �J�1�G�'C(jJ�2vN'a�i1'%�v� c2%J Aa <br />