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:ISN JOAQUIN COUNTY <br /> NOTIFICA`T'ION OF IIA'Lj;1:UOU5 DISCHARGE <br /> HEALTH h SAFETY CODE 25180 . 7 <br /> A. EMERGENCY LEVEL: II 1'II HEALTH DISTRICT LOG )) <br /> (Circle One ) <br /> B. SOURCE OF INFORMATION <br /> Original Source• _�� C'Q({S Telephone • (oql) Y?-306 <br /> 6 <br /> Reporting Agency Nance : Gp_ yii�ti�r�C' CvAgency Contact:Contact: ����ha� �'� a �� Telephone: &J )i N -3 tf�V <br /> Address : <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: <br /> to '4-S CL - t, <br /> (Best Physical Description) (City or Co nty ) <br /> Date of Discharge: ��p10 <br /> Date Notified: .3 Time • c/ a-pt,� <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business ;; - 7�0.c , <br /> V <br /> Contact Person• FYI • /� , �}�( Telephone• (JA) <br /> Physical Address : � to '� �Jr� P4 Sto n <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: <br /> Chemicals : <br /> F. ACTION TAKEN <br /> Ji e yr 3fiec`i�`oy,, <br /> o 7�- <br /> -w 7 fi <br />