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SAN JOAQUIN COUNTY • <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 pEDly <br /> C(a <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG #_ ��— <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name:— E-2,.,c— c—,t" Phone: <br /> Company:_ A:c� <br /> Address: <br /> Designated Employee Name: Phone: (_) <br /> Reporting Agency Name: <br /> Address:. in <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: P a-tt& and / �C <br /> (Best Physical Description) (City or County) Circle One <br /> Date of Discharge: _G • ?�7 _ - <br /> Date Notified: 9--,Aq— Time: g:,5-p A-m <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: <br /> Contact Person: — Telephone: (,_) <br /> Physical Address: <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: j;,c - <br /> Volume: -t- <br /> Chemicals: . ,M �— <br /> Circumstances• �, <br /> F. ACTION TAKEN S r ,)e,. ;u <br /> SITE DISPOSITION <br /> f. <br /> EH 22 013 (Rev.4/91) <br />