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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 ILE <br /> C <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG,, <br /> (Circle one) <br /> B. SOURCE OF INFORMATION <br /> Name-� [ CA-L 1AAf . Phone: ( ) <br /> Company: <br /> Address: Phone: <br /> Designated Employee Name <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> 1 <br /> Location: r Ct okrCoun�ty) rcle one <br /> (Best Ph.sical Description) <br /> Date of Discharge: T1'me:��= 0 , <br /> Date Notified: <br /> D, RESPONSIBLE PERSONIBUSINESS <br /> Name of Business: PhORe: QZ - 6 <br /> Contact Person: <br /> Phvsical Address' -5 <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: <br /> Chemicals: <br /> Circumstances: <br /> F. ACTION TAKEN f <br /> fite Ill, <br /> SITE DISPOSITION <br /> EH 22 013 (Rev. 08120198) <br />