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SAN JOAQUIN COUNTY <br /> NOTIFICA`T'ION OF 11AGARDOUS WASTE DISCHARGE O <br /> HEALTH & SAFETY CODE 25180 . 7 <br /> A. EMERGENCY LEVEL: <br /> � <br /> (Circle one ) lI III <br /> 1iEALTH DISTRICT LOG <br /> B. SOURCE OF INFORMATIO14 <br /> Original Source: r�J <br /> Telephone: <br /> Reporting Agency Name: <br /> y�G IJ/A-) <br /> Agency Contact: ��y-�/�� Telephone : ( ) <br /> Address : lav (,/ �- <br /> _ ys� <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: <br /> (Best Physical Description) <br /> (City or County) <br /> Date of Discharge: lJ/L,�A�,�-�. <br /> Date Notified; —13-1 3c� <br /> Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business <br /> Contact Person. � �ti <br /> /ry Telephone: <br /> Physical Address : <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: <br /> Chemicals : <br /> F. ACTION TAKEN <br /> ekw <br /> l� <br />