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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTl-I & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: (oil III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source:a zip Telephone: <br /> Reporting Agency Name: 1,,f/ <br /> Agency Contact: Telephone: <br /> Address: <br /> C. LOCATION AND DATE O <br /> F DISCHARG <br /> Location: Z -20 S °1- �Cun� ty) <br /> (Best Physical Description) (Cityor <br /> Date of Discharge: �/ ;�✓i <br /> Date Notified: <br /> Time: <br /> D. RESPONSIBLE PE SS <br /> Name of Business 27�-4e'�l OicAII/ <br /> Contact Person: �o� In Telephone: <br /> Physical Address: <�S_53 /,4✓,� � .�� l%��� � <br /> E. DESCRIPTION <br /> Type Release: ��� '� e ✓� / �o �irry t�a�► <br /> Volume: <br /> C11eIn1Ca1S: I e!'' <br /> F. ACTION TAKEN <br /> o <br /> . �-,. / �• r�Gz�✓mfr/ ` / <br /> 475 oI <br /> �iSSCs '/I <br /> 71 <br /> �r <br /> EH 22 03 (Rev. 7/89) <br />