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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISC GE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: L42, Phone: Li - 7`fZ,C <br /> Company: des <br /> Address: 179 4�� <br /> Designated Employee Name: ,�� f �` Phone: �s � c^3� <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: J,3 D,'� 60, <br /> (Best Physical Description) Ci or County) Circle One <br /> Date of Discharge- <br /> Date Notified: —2�7 Time: j4 M <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: ,&/' ("),V <br /> Contact Person: Telephone: (�22� -7 <br /> Physical Address: roe-sV 1,11-/ <br /> Mailing Address: �•r <br /> E. DESCRIPTION / <br /> Type of Discharge: <br /> Volume: OoFfknwo <br /> Chemicals: <br /> Circumstances: ►^ ✓� �'� <br /> F. ACTION TAKEN <br /> SITE DISP SITION &/0 <br /> EH 22 013 (Rev.4/91) <br />