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�J <br /> p SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: II III EH LOG# <br /> ( ircle one) <br /> B. SOURCE OF INFORNLATION <br /> Name: ffial(I'o V o UT ri r7 Phone: (M) 5'�Z• ^ v�0 <br /> Company: <br /> Address: 1.05 _}�- SGS YGyl lodts�v C 5 35 ! <br /> Designated Employee Name: ��n� '-�. Phone: GV°I a 8 (2 <br /> Reporting Agenc} Name: A�v1, U V avert <br /> Address: 20 E• U) �. 3 Floor- L G4 a5202- <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: r 0.Y IGI OL n ��' ! &V L��� <br /> (Best hvsical Description) ity r Count}) Circle one <br /> Date of Discharge: k n 0 W V' <br /> Date Notified: 2-1 0 3 Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: Vy, OV—w rA <br /> cT1 Y`NPhone: (ZD9 q-1'l o0 <br /> Contact Person: <br /> Physical Address: "0 E M0.YICt-1' S`eDG�- C4� aS2U�- <br /> Mailing Address: PO 50Y '1D0 S-�'DGKtD1'� U4• g52o1 <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: I ri.k'o V V-) A- <br /> Chemicals: WV&15. Crf <br /> Circumstances UST oy <br /> F. ACTION TAKEN RR -{A D <br /> SITE DISPOSITION ref k-�i l W Gly rel��r Cd j h-1 +A vkk <br /> SI-FL 15 awai �n L ` YCV-A-f atr <br /> EH 22 013 (Rev.08/20/98) <br />