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• i <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> • A. EMERGENCY LEVEII III PHS-EH LOG 9 <br /> L <br /> Pircle one) <br /> B. SOURCE OF INFORMATION <br /> Name:�i eC. V ec Phone: ( ) 4(02--493f <br /> Company: <br /> Address: S 4 <br /> Designated Employee Name: Phone: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: Q F i 04 99 <br /> (Best Physical Description) (City orounty) circle one <br /> Date of Discharge: -4(G <br /> Date Notified: }�2� �i� Time: '360n. <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: r <br /> Contact Person: c>l^ Phone: <br /> • Physical Address: Z z <br /> Mailing Address: B) -13Cx t V-CA N G r4r Q, .✓�1 FQ CA �i 522 J <br /> E. DESCRIPTION <br /> Type of Discharge: jLr 09ir <br /> Volume: lM ANAY\ <br /> Chemicals: — <br /> Circumstances: T�Lv,,�A d NI cq 4(A k v �)C--C <br /> F. ACTION TAKEN ✓ <br /> —T �D t i l tj:j M .✓�R'�xC 'j t( <br /> SITE DISPOSITION a n r 4 ✓� f f`j ��^� y�- <br /> • <br /> EH 22 013 (Rev. 08/20/98) <br />