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• SAN JOAQUIN COUNTY � <br /> Py <br /> O NOTIFICAIO &A�OWASTECHARGEHEALH SAFETY CODE 180.7 <br /> A. EMERGENCY LEVE LtP1'rcle <br /> II III PHS EH LOG # <br /> ( One) <br /> B. SOURCE O,,INFORMATION <br /> Name: f�'�1 °> uST -'0�••�,-r Gly Phone: <br /> Company: <br /> Address: <br /> Designated Employee Name: Phone: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF I CHARGE/���� _ s� <br /> Locatio �,a"�-he� ` ��TA c �ZZ 6t 141y4A 'iii / <br /> (Best Ph ical Description) W6r,(— City or County) Circle One <br /> Date of Discharge: UN Ou/n/ <br /> Date Notified: &JUN6 ! Time: Off° <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business% nd — 03 <br /> Contact Person: Telephone: <br /> Physical Address: S/5/ 014- <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharger ^ '� <br /> volume: ✓� £ <br /> Chemicals: �y'G <br /> Circumstances: <br /> F. ACTION TAKEN W <br /> SITE STATUS <br /> LLo <br /> EH 22 013 (Rev.4/91) <br />