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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE 4. <br /> _ Health & Safety Code § 25180.7 <br /> 7 <br /> A. EMERGENCY LEVEL � II III Health District Log # it 77 y <br /> (Circle one) <br /> 4 <br /> k <br /> B. SOURCE OF INFORMATION <br /> Original Source: 41w 6A&, f1LA&A-- &y,7A-atm Telephone: gV!—g363 <br /> Reporting Agency Name: <br /> Agency Contact: ,[Qzaz 6q4iLI�� _ Telephone: (_Epq ) qGb-G i7$1 <br /> Address: �?�_ " 7.r�o SrK�• ._ <br /> C. LOCATION AND DATE OF DISCHARGE - _ # r <br /> Date(s): Time: <br /> Location: 700 644,4au4 <br /> Best Physical Description) (City r ounty <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business:- <br /> Contact <br /> usiness:Contact Person: 15' Telephone: (LI ' <br /> Physical Address: KA. bv,t /u <br /> E. DESCRIPTION <br /> Type Release: ! <br /> Volume: r <br /> Chemicals: <br /> F. ACTION TAKEN <br /> �i <br />