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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DIS(HARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:01 III (a P YHS-EH LOG # ��r �S <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: la S _ Phone: LVCG <br /> Company: �— <br /> Address: <br /> Designated Employee Name: Phone:_( err) 4'(o�"-2V6 ,L <br /> Reporting Agency Name: S�� --�� <<; �c ��/�� /��. ��c SP, <br /> Address: -5- <br /> C. <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: <br /> (Best Physical Description) (Ci r County) Circle One <br /> Date of Discharge: <br /> Date Notified: 11-) ,19-2Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: /_9 11(2 C 0 <br /> Contact Person: s�.� "'i,e--, -e- 13 Telephone: (� <br /> Physical Address: / 731 <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: c�,� GY6 e <br /> Volume: <br /> Chemicals: <br /> Circumstances: <br /> F. ACTION TAKEN <br /> �f/ S✓P�"1SP<- <br /> SITE DISPOSITION -- 'e r ie; 4/: i, d /4, ,-, <br /> EH 22 013 (Rev.4/91) <br />