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SAN JOAQUIN COUNTY <br /> NOTIFICA71ON OF HAZARDOUS WASTE DISC*FLARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:� I III C <br /> j�r PHS-EH LOG # 1 — o� <br /> (�;fcle One <br /> G4 <br /> ti• <br /> B. SOURCE OF INFORMATION phone: <br /> Name: ua <br /> Company r 5PCy) <br /> Address: 159W i vd <br /> Designated Employee Name: Phone: <br /> U(o F? -z cl <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 151 5 W 47W c 6AK14 /3254 /5ql / C <br /> (Best Physical Description) City or County) Circle One <br /> Date of Discharge: ef'1/�y) <br /> Date Notified: 10 "-I I I G I Time: <br /> D. RESPONSIBLE PERSON/ US NESS <br /> Name of Business: Lt-c cq <br /> Contact Person: Telephone: ( / <br /> Physical Address: 201 W11�6 1 �r/7"p �� G/�"�' Ste' � �' 9 /1�5 <br /> Mailing Address: vow, <br /> E. DESCRIPTION / t K �r)� <br /> Type of Discharge: � / <br /> Volume: <br /> Chemicals: <br /> umstances: , So i a kil <br /> na O Gc i <br /> Z,t&m i IST <br /> F. ACTION TAMN, - -- —� <br /> SITE DISPOSITIONI l HJT � nfa�ta 1f-t cn GC/ <br /> Le- <br /> e- <br /> eC V,(W?a ca <br /> EH 22 013 (Rev.4/91) <br />