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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 COPY <br /> A. EMERGENCY LEVELO IIIPHS-EH LOG # G <br /> (Circle One) <br /> B. SOURCE OFINFO TIO <br /> Name: ^� Phone: <br /> (ZS 9 s 7 �� Z f <br /> Company: <br /> Address: Phone: <br /> Designated Employee Name: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCGE <br /> Location: 3 SIS /JN 6kv (City cle One <br /> (Best Physical Description) <br /> Date of Discharge: Z - TiS R <br /> Date Notified: Z- -7-�� me: 11 <br /> D. RESPONSIBLE PERSON/BUSIN$ S <br /> Name of Business: <br /> ^n, Cati� Telephone: (764) 57-Q-37 <br /> Contact Person: <br /> Physical Address: <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: �'� 0 <br /> Chemicals: <br /> Circumstances: <br /> F. A ION TAKEN <br /> SITE D[ POSITION r �-�' s� � y <br /> EH 22 013 (Rev-4/91) <br />