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i SAN JOAQUIN COUNTY • / <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE J <br /> HEALTH & SAFETY CODE 25180.7 <br /> cc � F�) <br /> A. EMERGENCY LEVEL• 1., I III 4-EH LAG # 93' 057 <br /> ircle One) <br /> B. SOURCE OF INFORMATION <br /> Name: B ES Phone: �) <br /> Company: / w- <br /> Address: d /0 b 9 Soo <br /> Designated Employee Na e: Phone: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE0 DISCHARGE /- <br /> Location: O3L/ /W! �RGOcic- / � / <br /> (Best Physical Description) (City or o ) Circle One <br /> Date of Discharge: /link vocJ'✓ <br /> Date Notified: S 7-P3 Time: /D ez., <br /> D. RESPONSIBLE PERSON ./BUSINESS <br /> Name of Business: axxy <br /> Contact Person: _ ati Telephone: <br /> Physical Address: S I CA- 933015 <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: <br /> Chemicals: enc r. c rk e Bch of T <br /> Circumstances: d <br /> F. ACTION TAKEN---Z,-,&- � oQ LGYa 0 <br /> _ / G <br /> Y <br /> SITE DISPOSITION <br /> EH 22 013 (Rev.4/91) <br />