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•6 SAN JOAQUIN COUNT 9 <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: LL7 e �Ou' Telephone: <br /> Reporting Agency Name: <br /> Agency Contact: Telephone: ( 1 y ) -- <br /> Address: D D c2 0 o � 5X2I C/ � �'� �i D/ <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: l��/`� T�iM U I<S6l�Un��c2/ S� <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: <br /> Q <br /> Date Notified: Time: OLS mJ <br /> D. RESPONSIBLE PERSONBUSINESS <br /> Name of Business ��(l2 ✓��� � G /S �'� �)l � S � <br /> Contact Person: Telephone: <br /> Physical Address: �� ll// ► 1 �� S�L�s2 't� <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: `L <br /> Chemicals: : <br /> F. ACTION TAKEN ,y <br /> ' C 'c7 // r / • �ti''v� I�.SJ <br /> / S /. C �1LG c�G e� CrSS C'SSz2 <br /> EH 22 03 (Rev. 7/89) <br />