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SAN JOAQUIN COUNTY (/ <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 y © ny <br /> A. EMERGENCY LEVEL: ©II III PHS-EH LOG <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Stent 3 L'�P,GtI. Phone: Z�) A <br /> Company:'AKLtx)P- Ci�T7,1?1 T�tr.ig-o U�=f � 11 r . <br /> Address: 1 lZS C,owl S rnct S uvn 7v?-wc t[ C-A 9S�rr1 t <br /> Designated Employee Name: Phone: Zo <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: SOO E- <br /> (Best Physical Description) r County) Circle One <br /> Date of Discharge: ()Ky4jo-,) 4 <br /> Date Notified: , lD Time: Fi A n <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: U ibi)> y- (7ize&Ls- FzZh <br /> Contact Person: -3-hu L3 Telephone: (Z6,j) 658 - co 20 2- <br /> Physical <br /> Physical Address: -DO E . Lnu 5c Avc- LaTMhZd o C A <br /> Mailing Address: PO Lj k t7--R 11R5>1R<rP �i5�?0 <br /> E. DESCRIPTION <br /> Type of Discharge: LONY tw7 SEL t nlc <br /> Volume: I��IGnlAsN <br /> Chemicals: 1J1��t��L FVE-L <br /> Circumstances: -5nt S/Jm,PLt2F;. 3UTZL6-,b <br /> rn,u-ri2-Am-D 3�( LPcFL2'cTllY2 / PNiYcistS <br /> F. ACTION TAKENlJ0P2 PUwJ SUP ntt 11✓� n> -P fiS2M <br /> SITE STATUS tN Pag, C r p) <br /> 0_0X,, JM t/U/,CZII 5t t-- -,k)r\fY 3P <br /> t tact <br /> EH 22 013 (Rev.4/91) <br />