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SAN JOAQUIN COUNTY i fz�6t�4 <br /> NOTIFICATION OF HAZARDOUS WASTE DISCIWG <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:I.J II III PHS-EH LOG # qo- <br /> (Circle <br /> One) <br /> B. SOURCE OF INFORMATION <br /> Name: BI`t- 7. l-A- Phone: 24-7v- c <br /> Company:_ 44� io <br /> Address:- P-o. <br /> Designated Employee Name: Phone: (_) <br /> Reporting Agency Name: <br /> Address:_ u-1-1-4z ,a,r <br /> C. LOCATION AND DATE OF DISX,�4-tr <br /> G <br /> Location: 00 2-' . Y-` Tc- <br /> (Best Physical Description) CZ dor County) Circle One <br /> Date of Discharge: <br /> Date Notified: ///s- Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: ' c, <br /> Contact Person: Telephone: Z. 6-70-S/01/ <br /> Physical Address: <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume:-7,---V G9c,�o,J�, <br /> Chemicals: r-q,_;A/,5 <br /> Circumstances: 192Go -7 L <br /> F. ACTION TAKEN /� ��.�E,� Dff a✓F GAF �,�v.�� f��,/� �'/ �•�iL L �/ �1L�o�(` <br /> SITE DISPOSITION f5;iP;i., ,� <br /> EH 22 013 (Rev.4/91) <br />