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SAN J0AQUIN C0LNTY46 <br /> NO'T'IFICATION OF HAZARDOUS WASTE DISCHARGE FILE COPY <br /> HEALTH & SAFETY CODE 25180.7 -- <br /> A. E`IERGENCY LEVEL..( II III PHS-EH LOG T - d� <br /> (Circle one) <br /> B. SOURCE OF INFORMATION <br /> o� <br /> Name: O/' Phone: PO7 , �7- 9OG <br /> Company: 7 iV <br /> Address: 'y' <br /> Designated Employee dame: Phone: <br /> Reporting :�.gencv Name: F �' <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> �/�lvci l l l <br /> Location: -5����- �✓ �TL' <br /> (Best Physical es ription) Ci County) Circle one <br /> Date of Discharge: L' b <br /> Date Notified: 0 LJ Time: —7-' c�i'> <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: <br /> Contact Person: r Phone: S 7- Ud <br /> Physical address: v' <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: > �� <br /> Chemicals: <br /> Circumstances: <br /> F. ACTION T. s /!/ <br /> yyi � <br /> SITE DISPOSITION /'v�r-i4 <br /> EH 22 0l3 (Rev. 08/20/93) <br />