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SAN JOAQ[JP1 COUNTY -��� E COPY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCH <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENT CY LEVEL0� cle <br /> I III PHS-EH LOG 9 / a <br /> one) <br /> B. SOURCE <br /> I OF INFOR:�LATION <br /> Name: A m Phone: <br /> Company: WI <br /> Address. <br /> Designated Employee Name I U V1 0 Phone: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DAT OF DISCKARGE <br /> Location: 2t)-5-� 5 . 0 T;U rl�d0 S� / Jta��D✓1 <br /> (Best Ph%,sl alUDe�cnption) ity or County) Circle one <br /> Date of Discharge: V!"DMI <br /> Date Notified: 2 Time: f1(\ll <br /> D. RESPONSIBLE PERSON/B <br /> I�USIN <br /> IIESS <br /> Name of Business: AI CIV -S CA VC <br /> Contact Person: � 1 IV0 ✓ Phone:� -64 - q92-7 <br /> Physical :address- 31Z$ AC-G(:)�AV2,+WL1 e Qr Aa r-) 35D <br /> Mailing AddressVYll1 QS Qb0�1P <br /> E. DESCRIPTION -' <br /> Type of Discharge: <br /> Volume: 0VVY1 <br /> Chemicals: MTB A <br /> Circumstanc Sc-�� VYl rQ Y <br /> F. ACTION TAKEN 1 Q—AA w V r1 LO Qt q . K <br /> V\1 <br /> SITE DISPOSITION V <br /> VYL <br /> >r✓V\ �v \ b2 p— I V. <br /> EH 22 01; (Rev. 08/20/98) <br />