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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE ( �� <br /> HEALTH & SAFETY CODE 25180 . 7 00 <br /> A. EMERGENCY LEVEL: II III HEALTH DISTRICT LOGr =a0/o <br /> (Circle One) fill.... �i <br /> B. SOURCE OF INFORMATION d <br /> Original Source: --�ACr?-' rT <br /> Telephone: <br /> Reporting Agency Name: <br /> Agency Contact: LA9ylj <br /> Telephone: 4&s,-3Yelj <br /> Address : �(p01�E( � / <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: <br /> Date Notified: SS & <br /> Time: <br /> D. RESPONSIBLE PERSON/B-�U-SINESS <br /> Name of Business <br /> Contact Person: ? <br /> Telephone: (4b) ?�7 <br /> Physical Address : <br /> �lr ire I S/ c E. DESCRIPTION <br /> Type Release : ShU <br /> Volume: 75-SSC.! Rte_ -------------- <br /> Chemicals : Ilj�i�iG �(9Gl <br /> F. ACTION TAKEN <br /> ro <br />