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SAN JOAQUIN COUNTY `/C• <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL0II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: StqSS Q rJ Phone: a <br /> Company:S�aw Joar4-f 6v0(,n& zozivi r.-ISri-girls h40iyr"b& <br /> Address: Yy• .env 3?2 SrUCK 6n1 CA 4S--o1 <br /> Designated Employee Name: STt-vF�j f 19Xr6.,J Phone: zo ) - 3,Vs <br /> Reporting Agency Name:.!�i - i cam vir�l� <br /> Address: P. P. E rsx .322 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location:574&7 D-Z4 D1�� dl-17--7,r,;,W, ,,,✓o-k /V. <br /> (Best Physical Description) City r ounty) Circle One <br /> Date of Discharge: b <br /> Date Notified: 3 Time: '06 <br /> D. RESPONSIBLE PERSON BUSINESS <br /> Name of Business: <br /> Contact Person: Al-�e,^ecl Telephone: (2o9 -?'r- 7 90 <br /> Physical Address: AR SD 5Z 7 <br /> Mailing Address: /,;?7-5'0 S3 <br /> E. DESCRIPTION <br /> Type of Discharge:--41 kkl,02A <br /> Volume: 01 <br /> Chemicals: <br /> Circumstances: 14q all aar a c�✓ f <br /> F. ACTION TAKEN ✓ i�-� �ncr 7 dY�/1'/rC` �71 �LU p C 1� <br /> SITE STATUS d <br /> EH 22 013 (Rev.4/91) <br />