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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: Y S Telephone: Li--q <br /> Reporting Agency Name: ___�_.._ � <br /> Agency Contact: _ Telephone: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHAR E <br /> Location: „- ��1 fir;C,C, B _ 1 Tnc�- <br /> (Best Physical Description) ity r County) - <br /> Date of Discharge: 'ny ) <br /> Date Notified: „ 2 `f I Time: q, 2 <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business �0 2[ a� 60vnn�jACt�1 �ev'JtcQS <br /> Contact Person: :50" b� N"l e� Telephone: —q S <br /> Physical Address: <br /> cv vA� Y10 R-aM L-vq <br /> b � <br /> E. DESCRIPTION o n . C a 1 L C-o e"n La <br /> Type Release: <br /> Volume: <br /> Chemicals: <br /> Gr,cvr ��s C-Site far. v.a�ti1 - cfite.-t' pern.�- vis c ,n CU <br /> -t- <br /> ACTION TAKEN o~o�e�~ped ��•��aw,��a-he�i soy! fxti,� h�tut.��-r �sel f- <br /> r UZ hLk D� I '� c1S a011n5 SO t O�fi5 l , `2 <br /> 'r nzL)d J Gia 0�+ kkr -+ V012 HW11 b <br /> ar___._ a (Q u •��X fil #'hem �(I tJc� rQL <br /> EH 22 023(Rev. 02/90) <br />