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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTEE DISCHARGE <br /> H-F,LTH & SAFETY CODE 2SISO-7 , <br /> ,,.{ 4GENCY LEVEL: :---IL• �� �.. :..�. , .... -, "'. PHS-EH:LOG <br /> (Circle One) <br /> 3: <br /> 8, <br /> SOURCE,,CSF 7R1 T }} � h <br /> Phone: (ZLo4) <br /> Name•... , <br /> P w <br /> co a� <br /> AddlresSv , <br /> Deszgx�ated E=*Yee Naare; <br /> Pbj e; (� <br /> R:�n� � Namur <br /> Address:. <br /> Af <br /> /+Y <br /> :fir. LiOCKMLY <br /> D DATE 0 G.E <br /> Locattaxz. <br /> {Bes[ Plcal. d c-z tion} COY ) Ckdie One <br /> Date of oischAqet. <br /> .Date Nddfid : Tune: <br /> D� <br /> RESPONSIBLE:P SPWPUS gE-cs � u <br /> Name of,Business. �. <br /> CrGlIIt3C P e'"'aC7Y1: r r i � <br /> Physical Addresst. <br /> i aLlin Address. <br /> D ESCRaMON' <br /> Type oz Disc e: <br /> Volume: � O <br /> :. ACTIC?N TAIL <br /> '5. -r- a.� ' <br /> 3 <br /> a <br /> StTc D(SPC}Si O 'Gr-r4 f z 4a f <br /> ,. A� ,+ ,�s-•. , - { '?�.s irr rte:-iC.. <br /> EH' 22:013. <br /> 7t.4 9; <br />