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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH 6 SAFETY CODE 25180 . 7 <br /> A. EMERGENCY LEVEL: HEALTH DISTRICT LOG # <br /> (Circle One ) <br /> B. SOURCE OF INFORMATION <br /> L.Z. <br /> Original Source: Re�ost Telephone: (q« ) 472 - 40(0 <br /> Reporting Agency Name: SAS Soa9„ Locot �leAl+t. �,5�,,;�t <br /> Agency Contact: Dav:A co-As — Telephone: ( 2-9 ) Y(o8- i 4vo <br /> Address : loo( E . lla�et�e� { P- o_ 40.E 2��g S�o���� cA <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: Av-jt .•.- <br /> Dr. / 1 ✓�� <br /> (Best Physical Description ) ( City or County ) <br /> r I <br /> Date of Discharge: <br /> Date Notified: 2� ��k Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business �+ • Te ����t So.� Z�� <br /> Contact Person: Da- Telephone: ( 2-6 ) Fr3s-y431 <br /> Physical Address : Zaoga S . ��� A,tt r �� . Tv��� i <br /> E. DESCRIPTION <br /> Type Release: -- U✓�c:� td�� ri z�rFe <br /> Volume : <br /> Chemicals : q sit, e <br /> F . ACTION TAKEN <br /> Cha ;tido c,o� e�lecl ra <br /> rr <br /> p✓Oge�1.1, Aa <br /> C(DPY <br />