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SAN JOAQUIN COUNTY <br /> NOTI KATION OF HAZARDOUS WASTE L.,..HARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:CII III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: S.. Or, � �, la S - _ Phone: <br /> Company: 1::-1,,Z <br /> Address: <br /> Designated Employee Name: (7,,-z-V ce- - Phone:_QL2) Y2V6 .L <br /> Reporting Agency Name: <br /> Address: s <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: Z30 s 6-21%5�, L-2 c t / <br /> (Best Physical Description) 12' (City or County) Circle One <br /> Date of Discharge: r/g-1- - <br /> Date Notified: ,/9 .2- Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: 1\' Ccs <br /> Contact Person: Telephone: (_) <br /> Physical Address: l 73iS 4--t, "le Z<< /C xv- <br /> Mailing Address: �' �� ��s ' ��'70' <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: <br /> y Chemicals: <br /> Circumstances: o �� <br /> F. ACTION TAKEN oe s/o•�f- / C/If ce—e s >,l( w �G e"S Is <br /> SITE DISPOSITION Sr ,�� r t <br /> EH 22 013 (Rev.4/91) <br />