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SAN JOAQUIN COUNTY SC'ciARGE <br /> COP NOTIFICATION OF HAZARDOUS 'HASTE DI <br /> HEALT'ri & SAFETY CODE 25180.7 �T <br /> A. EMERGENCY LEVEL: I It III <br /> PHS-EH LOG <br /> (Circle One) <br /> B. SOURCE OF INFOiLMATION �� ado _ phone: <br /> Name: �� ^ 1� ;r�� Aa G <br /> Company: Q <br /> P Y� <br /> Address: Phone: Qzy <br /> Designated Emoloyee Name: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATIONSNID A OF DISCHARGE / <br /> Location: � (City or ounry) Circle One <br /> (Best Physical Des prion) <br /> Date of Discharge: , <br /> Date Notified: 1 '1—A9— 9� Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: H i a� i Telephone: <br /> Contact Person: <br /> Physical Address: <br /> Mailing Address: <br /> E. DESCRIPTION # a <br /> Type of Discharge: U 6 _ <br /> volume: <br /> Chemicals: S <br /> Circumstances: — <br /> Ja <br /> F. ACTION TARN <br /> A s <br /> SITE DISPOSITION S e SS <br /> EH 22 013 (Rev.4/91) <br />