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SAN JOAQUIN COUNTY <br /> NOTIFI'ts�(TION OF HAZARDOUS WASTE Dte,HARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL. I I III PNS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: (_) <br /> Company: <br /> Address: <br /> Designated Employee Name: es c-71 Phone: <br /> Reporting Agency Name: 5a, o o 4,,cl ( C-t?' <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: �)-1 U 1 -,r; , C ,.,r-,-t s L, -i <br /> (Best Physical Description) (City or ounty Circle One <br /> Date of Discharge: 1,:j !-` <br /> Date Notified: S' /q 173 Time: d cc <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: w e l l a <-r1 <br /> Contact Person: aj, 11 i a --\ -t Telephone: (2!ED- YX 7-33 / <br /> Physical Address: a1 o t e,rts e K <br /> Mailing Address: _ f� 0 , rs c C-14 <br /> E. DESCRIPTION <br /> Type of Discharge: XL <br /> Volume: /,/" ?L,,to <br /> Chemicals: rtfe-/ <br /> Circumstances: e e-g.,j its a ,-/. <br /> UST ��mncl2 1 <br /> F. ACTION TAKEN r -P rid <br /> Qe-cam"b ef- 1 _sd <br /> SITE DISPOSITION UST �l a, <br /> ter- i.elr/e's ee <br /> Ell 22 013 (Rev.4/91) <br />