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SAN JOAQUIN COUNTY HAJL E COPY <br /> NOTIFICATION OF HAZARDOUS WASTE DISC <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVELPircle <br /> II III <br /> PHS-EH LOG 4 O a - 61 0 <br /> one) <br /> B. SOURCE OF INFORMATION <br /> Name: t -Phone: ( ) <br /> Company:___j&� � S 53 <br /> Address: C: ` <br /> Phone: 7�l <br /> Designated Employee ame: � <br /> Reporting Agency Name: �1 �eaa r ti's J <br /> 0- <br /> 1"-Address: 3 6�-1 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: ity o County) Circle one <br /> (Best Phvsical Description) <br /> Date of Discharge: Time: <br /> Date Notified: -251 15,1 <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: los -Taha�, Phone: 1.4�3 <br /> Contact Person: 9 S 24 2� <br /> Phvsical Address: <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: v <br /> Volume: <br /> Chemicals: 6<1: <br /> Circumstances: U <br /> F. ACTION TAKEN <br /> SITE DISPOSITION ej <br /> EH 22 013 (Rev. 08/20/98) <br />