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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL( I II III PHS-EH LOG # 9,2 -)2 f <br /> Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: h/(< C Phone: z•n <br /> Company: Y c o <br /> Address: ? S, <y <br /> Designated Employee Name: Phone: <br /> Reporting Agency Name: d-� <br /> Address: `f `-1 S ,+. <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: / 7// e1n, Az / �Y G" r�s <br /> (Best Physical Description) (City or County) Circle One <br /> Date of Discharge: `>G - 9? <br /> Date Notified: -z`/ _a z Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: o d Z� <br /> Contact Person: _ . Telephone: (2L �/07 - Z 6 Y <br /> Physical Address: <br /> Mailing Address: i7-3 K , <br /> r <br /> E. DESCRIPTION <br /> Type of Discharge: Lull �� �'�'�° <br /> Volume: 2 <br /> Chemicals: <br /> Circumstances: mel- c/,- � <br /> F. ACTION TAKEN /,fir z rt 5 <br /> /•oma �',�C dl -1v �-}r�(FJ t?i'ol,I�/ �v �,�c� Di1 <br /> l'�lYI o7 T Q// DG v L'r✓J z''i�T - <br /> SITE DISPOSITION <br /> EH 22 013 (Rev.4/91) <br />