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/ V <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVELO II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: I t i �. RP-SC . Telephone: ( o�j ) �o�' :a' <br /> Reporting Agency Name: <br /> Agency Contact: Telephone: (� �� �`3d <br /> Address: <br /> C. LOCATION AND DATE OF DIISCHAyRGE <br /> Location: 2& :Z4f Ci �C-i'f G f7(� l <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: <br /> Date Notified: Time: o d <br /> D. RESPONSIBLE PE SO BUSINESS <br /> Name of Business 'f�J <br /> Contact Person: j Telephone: Y7 5 <br /> Physical Address: 336 / F0-1661-.661- i w Wa-z-/, San C/3 9`f S U <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: <br /> Chemicals: <br /> F. ACTION TAKEN <br /> ee <br /> (249 lax:6� a.2�Im LIZ-,Ita -6zxj aoa <br /> J <br /> EH 22 03 (L. 7/89) <br />