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SAN JOAQUIN COUNTY (;CMD <br /> NOTIFICATION OF HAZARDOUS WASTE DISC <br /> HEALTH 3c SAFETY CODE 25180.7 <br /> A. <br /> EMERGENCY LEVEL I II III PHS-EH LOG <br /> ircle one) <br /> B. SOURCE OF ENFO/ItMA/TION <br /> Name: -Phone: (2,o) <br /> Company: <br /> Address: 2-(TZ ✓i') Ta cia- <br /> Designated Employee N e: Phone: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: MM4A A...AJ IRR e4AO <br /> (Best Physical Description) iry or County) Circle one <br /> Date of Discharge: (Jt,k <br /> Date Notified: Time: <br /> D. RESPONSIBLE PERSONBUSINESS <br /> Name of Business: / <br /> Contact Person: I I JA {— Phone: <br /> Physical Address: <br /> vlailing Address: UA. & <br /> E. DESCR MON <br /> Type of Discharge: 61"tK. <br /> Volume: <br /> Chemicals: <br /> Circumstances. d•S• <br /> F. ACTION TAKEN JeLl aml�pl <br /> SITE DISPOSITION <br /> dci,o < <br /> EH_22 01-, iRec. 08/20/98) <br />