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we <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> Health & Safety Code 4 25180.1 <br /> A. EMERGENCY LEVEL II III Health District Log N <br /> (Circle one) <br /> 1) <br /> B. SOURCE OF INFORMATION <br /> Original Source: 07 Telephone: ) 5 — <br /> i <br /> Reporting Agency Name: <br /> Agency Contact: Telephone: �� <br /> Address: <br /> 9�s C. LOCATION AND DATE OF DISCHARGE <br /> Date(s): ,Z3 —Sl Time: ;( � /yl• <br /> l Location: / <br /> J Best P sica scription ty or Cou ty <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: <br /> Contact Person: Telephone: <br /> Physical Addres <br /> ,;l <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: <br /> Chemicals: 17 <br /> F. ACTION TAKEN <br />