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rnr� SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> PHS-EH LOG #—q-1-.I 7 <br /> A. EMERGENCY LEVEL:� II III P11( ucle One) � <br /> B. SOURCE OF INFORMATION l�� phone: <br /> Name: /�Lr e fa �"a n L Aey�l/ <br /> Company: GA/ rz r Gn/E <br /> /2.OA <br /> Address: / S ✓� ✓ one: <br /> Designated Employee Name: U/�/ 777_1 <br /> Reporting Agency Name: 17Pr_ _7 <br /> II <br /> Address-.L nom`' <br /> C. LOCATION AND DATE OF DISCGE u/1 15x37 d <br /> Location: �'�✓ U ' " ' �� / (City or ounty) Circle One <br /> (Best Physical 0escriI on)� <br /> Date of Discharge: Time: <br /> Date Notified: <br /> D. RESPONSIBLE PERSON/BUSINESS f c��hlP <br /> Name of Business: • 5 <br /> Contact Person: !�L F 2 F A L d r o✓. Telephone: 0 <br /> Physical Address: / <br /> Mailing Address: vn <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: <br /> Chemicals: L <br /> Circumstances: <br /> .tom a <br /> K <br /> F. ACTION TAKEN %Gt�O 3 oCd c //UY UH � ��JS c-l i nye S <br /> 1,I r?.w,oII <br /> i_0 11A ( <br /> SITE DISPOSITION 'i- 'r e <br /> rrI r� <br /> EH 22 013 (Rev.4/91) <br />