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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: (D II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: �u�.,,/ c��- Telephone: 2v9 ) <br /> Reporting Agency Name: �S�h J oa �,�"" ��' " /,L�<<N� -' I I I;f <br /> Agency Contact: Telephone: <br /> Address: /Ys �y, ��, v<� 9u�=� 5/,l C4 <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: f."-/7a/r / <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: -�1�� °� ^-- <br /> Date Notified: l°-a 3 - J Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business L�� <br /> Contact Person: /- a/,/cc Telephone: (-)o y -7 7 7 <br /> Physical Address: <br /> E. DESCRIPTION <br /> Type Release: —�'— <br /> Volume: r <br /> Chemicals: <br /> F. ACTION TAKEN <br /> Ae? s;,�- <br /> . rtl. /ri/lSli S <br /> 4e <br /> EH <br /> C''/i✓t•' / IRcJ� �/1 ! -Sc"�,[r' rJ< s i �z:wf r�'�c-C.C.c-li <br /> EH 22 013 (Rev. 02/90) <br />