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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 #--21 '-Q5 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION ti 1 <br /> Name:_ Chc(rfp-- f Phone: if g•3yyo <br /> Company:_ Sam �� xnu v cam , Pub�,� f{talfR Ices <br /> Address: <br /> Address:_ <br /> Designated Employee Name:- c• Hunk- Phone: CZgL) qwP- �yya <br /> Reporting Agency Name: 15;' ,J.C, PH s -f-HD <br /> Address: i?o. s+ .k0 y <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 221 ' Chrr!i, l 57-, <br /> (Best Physical Description) i r County) Circle One <br /> Date of Discharge: IL,P.w04,0v <br /> Date Notified: ;c,fy,Jar Time: N If,cLo A,--z <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: rdc sr- Truc�i�ri <br /> Contact Person: JoA,) Urr-,Ji e,,. �L�,,.�k o, r,�.r�(-ou Telephone: > 9yl-IZ 7s- <br /> Physical Address: 3-3s- /y sf s4oc t- o, ) <br /> Mailing Address: i? o. C3ox 1110 s-4v�� ni 9--.201 <br /> E. DESCRIPTION <br /> Type of Discharge: U,4 k- , <br /> Volume: ccNxNcc,..�, <br /> Chemicals: P 1x61 Pa,, by,- �rrfbc <br /> e <br /> Circumstances: pis � off' n lec�►,-, av� 0 Prr�7 47;?�,e <br /> F. ACTION TAKEN_ i titer-.�k o� Sxa.ie3oN - Pro�r•{� doe.w� G+c�s �'�e. �, . <br /> SITE DISPOSITION T p_ ��, Z c>,,e yrs./ crx,,- .2 114' mat 4u -r r• -7".T;s <br /> t -�-Ae 1?TS� E-rrc ,tip-c%t ) d <br /> i <br /> .-�a u� o'�' � Gd e g, T' c a e � c •u on, -fIv_ <br /> _ �l�oue koala�, ate° l•c�'�ri�,�.l Cirri► o• fie s-� s rte?` -f-l. s�;�/� c,��ErN yo <br /> EH 22 013 (Rev.4/91) <br />