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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:[[ III PHS-EH LOG #- -/d 7 <br /> (Circle One) <br /> B. SOURCE INFORMATION <br /> Phone: 3lv '1o7�Z6oj <br /> Name: <br /> Company: 2�Z�c� Cid 9070 � <br /> Address: /77/ ��c�/�f_rs' �c12 sc�9� Gc�'P`` <br /> Designated Employee Name: Phone. <br /> Reporting Agency Namf <br /> Address: 414/ nl siq 5� 4`�l' <br /> C. LOCATION AND DATE OF DISCHARGE Gbp� <br /> Location: <br /> (Best Physical esc 'pilon) mor County) Circle One <br /> Date of Discharge: 6 - <br /> Date Notified: Time: .,,r '/Ai ct q <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: <br /> Contact Person: Telephone: (2L3, qo7 Z-60 <br /> Physical Address: 17 '�/ Gi �i%vDEf3AG � go7o 1 <br /> Mailing Address: A ��54 oA/J�leCz�2?CiZ GA 4? <br /> E. DESCRIPTION <br /> Type of Discharge: v S <br /> Volume• C <br /> Chemicals: v aw <br /> Circumstances: G w E <Gi m <br /> F. ACTION TAKEN <br /> SITE DISPOSITION �//I�k/✓DLu /I; Ii6�5 <br /> SITE - � �� i`*/1 Y I-1eZ E r <br /> ,14 t �F mon/pN*�tik9iorcl <br /> EH 22 013 (Rev.4/91) <br />