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SAN JOAQUIN COUNTY 4 <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: II III <br /> (Circle One) PHS-EH LOG - 7 <br /> 0 <br /> B. SOURCE OF INFORMATION <br /> Original Source: C Er Telephone: (± <br /> (o 2—��p I <br /> Reporting Agency Name: & - �c�2i/iG�� <br /> &VI saw <br /> Agency Contact: •�/ c. Telephone: (_ZLrj) <br /> Address: lO 4. top C2- CSZO <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: I&12 dr�m m&YL, "Lx,/ <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: (A-NLeh <br /> Date Notified: 2 Za Time: tw <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business CC) C1- ,9 W 6¢8 <br /> Contact Person: 1 LS CSL} VL"� Telephone: (_4L67� `571 — 24-OQ <br /> Physical Address: I!vl� �-,�-t c� (�• /�r-- <br /> E. DESCRIPTION <br /> Type Release: . <br /> Volume: <br /> Chemicals: &SC3 WAAS '' <br /> F. ACTION TAKEN <br /> -4&x5a-W-b Oe i/V17A-L PJ�o'�T1G a rL <br /> lc� <br /> � Cfrx! <br /> EH 22 03 (Rev. 7/89) <br />