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, OP of <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I@II III PHS-EH LOG # � - <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: pt,-fk-Inn ugni= Ph�c rt- Phone: (meq) <br /> Company: <br /> Address: SLCD i-L4 <br /> Designated Employee Name: Phone: �) <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 5, <br /> (Best Physical Description) (City o CouCircle One <br /> Date of Discharge: 8f i la 2 nty -- <br /> Date Notified: Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: roc cP,� <br /> Contact Person: rm rnn�� Telephone: (20q) ,3(oG-35 <br /> Physical Address: -wj 22 021 95ZZC <br /> Mailing Address: �,�. �o�c �,Pow C✓� gS220 °i'rr►� '-��, Cho _ <br /> E. DESCRIPTION <br /> Type of Discharge: CraSl�- <br /> Volume: til anS - <br /> Chemicals: "r�2 ie-tor" "f�5ar,a xL" d-"t nnnat� " <br /> Circumstances:(.m,Q r,n!2s�-, 01f\A1,tA n-L 01 r P(X- on r-u n w Q wh ch <br /> CCu 5e d nes-rrc A A A 04,l-x1-f' <br /> F. ACTION TAKEN <br /> ,,, a� �-• (�P r �Y'� i r1 �__c S/�r� 1 oQQ i' f7 CO �_l C�m m i x i or�rc n��,n N � <br /> SITE DISPOSITION <br /> l 1 res 0-r o (Jo�-ts cevn to ICY oa- L242CML <br /> (',Una R(, E0�T - <br /> �� <br /> EH 22 013 (Rev.4/91) <br />