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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH 6 SAFETY CODE 25180 . 7 <br /> A. EMERGENCY LEVEL: II III HEALTH DISTRICT LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: ZMVV_4,062 6I A /rU &)Telephone: (_) <br /> Reporting Agency Name: 4" Leod <br /> Jf <br /> Agency Contact: i Telephone: 1Lp�) c�� �. X2 <br /> Address : e 0 Pj)( L-2-00ct 5�a kk n <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: N-5"5- V on s / - %9� I n <br /> (Best Physical Description) (City or unty) <br /> Date of Discharge: up pry <br /> Date Notified: 1{ [�_ �u Time: or,4n <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business �jy\ rj._.n h 24-0 e I ! n <br /> Contact Person: pw hZ-Q ( L's Telephone: <br /> Physical Address : f�S s /[��n may` sr� Jam✓( <br /> E. DESCRIPTION n I <br /> Type Release: <br /> Volume : tA1n �r�nl,�y� <br /> Chemicals : �Z'c� tx �QY� !Z4 si a <br /> ['. ACCTIIO�N TAKEN I <br /> —1L1L.LCL6� lMlllie�p�y F uunen D*�C.11/�� <br />