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SAN JOAQUIN COUNTY <br /> NOTIFICAMON OF H.-�ZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 J <br /> E <br /> A. EMERGENCY LEVELQcle <br /> II III PHS-EH LOG # <br /> One) <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: L ) J <br /> Company: <br /> Address: <br /> Designated Employee Name: Phone: <br /> Reporting Agency Nam7: Sot,w <br /> Addres E S <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location:70��= � <br /> (Best Physical Description) Oor County) Circle One <br /> Date of Discharge: vw�i . <br /> Date Notified: (,moo 4 : - Time: <br /> D. RESPONSIBLE PFRS,OtyBUSINESS <br /> Name of Business: <br /> Contact Person: ,s Telephg�e- t- ) =z6 6 7 <br /> Physical Address: S <br /> Mailing Address: <br /> E. DESCRIPTION ' <br /> Type of Discharge: o-l' <br /> Volume: <br /> Chemicals: <br /> Circumstances: <br /> F. ACTION TAKEN <br /> w <br /> SITE STATUS a <br /> k <br /> J <br /> EH 22 013 (Rev.4/91) <br />