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w' <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF 1-U,,ZAIZDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG # <br /> (irele One <br /> B. SOURCE OF INFORMATION <br /> Original Source: ��,ty ,�.f-v�( Telephone: <br /> Reporting Agency Name: -,460e— h--w F/ <br /> Agency Convict: _ !�`T/7/.9 Telephone: <br /> Address: <br /> T <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: V3/<- / <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: <br /> Date Notified:Notified• a -2 -S70 �o" <br /> Time: - �--� <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business Ly ifs Si�L-ZG. <br /> Contact Person: / Telephone: ZG c2 <br /> Physical Address: 4 C04 Sle-d-3 <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: <br /> T <br /> Chemicals: Cil�l l�►t-PJ <br /> F. ACTION TAKEN <br /> 1e� yo /z6 F� i <br /> 1 , <br /> EH 22 013 (Rev. 02/90) <br />