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w <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: II III PHS-EH LOG ,, <br /> (Circle One) <br /> B- SOURCE OF INFORMATION Y oaG <br /> Name: 1 "YYl d i1 t S v �f` t Phone: qj 45� <br /> � Company: <br /> ' Address: 1 o r <br /> Designated Employee Name: Phone: [ ) <br /> t <br /> Reporting'Agency Name: r <br /> Address <br /> C. LOCATION AND DATE OF DISCHARGE 31 <br /> ` Location: 08 . G favet <br /> t Ci or County) Circle One <br /> (Best Physical Description) • <br /> Date of Discharge: <br /> Date Notified: WAa q 1994- <br /> Time: [o OD <br /> i D. RESPONSIBLE PERSON/BUSINESS il <br /> Name Gf-Bw4ne,3s: r e-s <br /> Contact Person: Telephone: <br /> Physical Address: 21 4-7 E�- L -wu 5b2-0L+-6--r\ C- pis 2 05 <br /> Mailing Address: <br /> N <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: k-� <br /> Chemicals: Ok QLC,6 ``, <br /> Circumstances: gnyn CW1 c,I <br /> F. ACTION TAKEN ai'G e bu J��y�r+o Jr S �1 I �� Q►'�� <br /> SITE STATUS i i rq vn Pte'i `� [ <br /> x <br /> T I. <br /> EH 22 013 (Rev.4/91) <br /> j <br /> j <br />