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SAN JOAOUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARG' <br /> HFALTl-i & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL I II �� III PH �H L4 # <br /> (Circle One) J U <br /> i. <br /> B. SOURCE OF INFORMATION <br /> Original Source: ace Telephone: C&!L 3711?-/ 3 <br /> Reporting Agency Name: ✓r ► ,� S <br /> Agency Contact: Telephone: z dy <br /> Address: Z�0/ <br /> C. LOCATION AND DATE OF; DISCHARGE <br />. Location: /� <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: w 161z2n 4 J!'0'9 <br /> } Date Notified: Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business G M enS <br /> Contact Person: <br /> Telephone: <br /> Physical Address: 3 5 rv(� V�rn��s i2 la1141111s <br /> E. DESCRIPTION ' 5 3 <br /> 71 pe Release: -77" <br /> U <br /> Volume: ,�/JG�✓ <br /> Chemicals: <br /> F. ACTION TAKEN <br /> - <br /> 76 00 <br /> C caC/ / t�C <br /> ce <br /> 77Z'17 <br /> el - <br /> /'C /ir ci T7cJ✓ �, S <br /> EH 22 03 (Rev. 7/89) <br />