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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180 . 7 <br /> A. EMERGENCY LEVEL: ID II III HEALTH DISTRICT LOG # <br /> (Circle One) -7 <br /> B. SOURCE OF INFORMATION <br /> Original Source: �„�_-� � j� ���,� Telephone: ( ;-0;) S"Z 7_Vt, -0 <br /> Reporting Agency Name: L <br /> Agency Contact: /(.i<ct t.� Telephone: (Z_0fl F 3 VZ6 <br /> Address : !)• /7 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: <br /> Date Notified: ��� Time: /0.'(C <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business <br /> Contact Person: Telephone: ( Z c`7) <br /> Physical Address: ,A C p t <br /> E. DESCRIPTION f <br /> Type Release: <br /> Volume : <br /> Chemicals : % z �,� ` l A-* <br /> F./ ACTION TAKEN <br /> 42 <br /> ti <br />