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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:( 1 II III PHS-EH LOG # 7 <br /> (Circle One) COO <br /> C! }� <br /> B. SOURCE OF INFORMATION <br /> Name: frart U 0- r Ce - Phone: 10 ) 43/-a3GG <br /> Company: L <br /> Address: <br /> Designated Employee Name: to 'hone: q/.'- ?eI6 fl <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF D[ CHARGE L <br /> Location: q &A g &:tN <br /> (Best Physical Description) (City or, ounty Circle One <br /> Date of Discharger - > <br /> Date Notified: 7— !F- 9.;k, Time: 3 ;011 o <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: N; t buJy E- D0- 6 Dy m <br /> Contact Person: S Telephone: Q89)431- /d'754 <br /> Physical Address: '110 a h/2%, �1 Ca /2- <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: <br /> Chemicals: <br /> Circumstances.'J 3 o q <br /> F. ACTION TAKEN L wCe 4� i`t��r�vt Uv P <br /> �-i P/Xi rAtcr 7�s� 4Le� a Oxyy;,s <br /> SITE DISPOSITION e ' <br /> 02 <br /> iLv <br /> EH 22 013 (Rev.4/91) <br />