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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: II III PHS-EH LOG # 6?� <br /> ,rcle One <br /> B. SOURCE F INFORMATION <br /> Name: - Phone: ✓?-3sa�F <br /> Company: <br /> Address: /7io /1far.•c_ �a em1 , �S3 a o <br /> Designated Employee Name: Phone: (_) <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION PD DATE OF DISCHARGE <br /> Location: — /✓�� � <br /> (Best Physical Description) �lor County) Circle One <br /> Date of Discharge: <br /> Date Notified: 7/5-fZ Time: Fal- <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: Z� d �SS� c� � r <br /> Contact Person: Rf- B �e Telep ne: 52�9 - F5 U <br /> Physical Address: 0305 V- <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: <br /> Chemicals: rhe -�►� � w <br /> Circumstances: <br /> F. ACTION TAKEN <br /> SITE DISPOSITICN <br /> 94) cap <br /> EH 22 013 (Rev.4/91) <br />