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L 21 <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE CD <br /> i HEALTH & SAFETY CODE 25180.7 } <br /> I <br /> ., + <br /> I <br /> A. EMERGENCY LEVEL II III PHS-EH LOG # <br /> cle One) <br /> 4, <br /> B. <br /> B. SOURCE F INFORMATION ! <br /> j <br /> Name: Wl! C o ! Phone: (?(0 �3 - ��A <br /> Company: Oi (z II I h <br /> Address: D as d r 9'd2 D - Oil <br /> Designated Employee Name: 'll <br /> 8nPhone: IL__L} <br /> Reporting Agency Name: <br /> a <br /> Address: !! II <br /> li r <br /> C. LOCATION AND DATE OF DISCHARGE iI II <br /> Location: W,t 1k! Uj <br /> (Best Physical Descri do I. City County) Circle One <br /> g <br /> Date of Discharge: !R S IIS '! <br /> 1 <br /> Date Notified: 2 Time: II -J Ob 0 <br /> i <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: <br /> j Contact Person: Cit ' `( t0 II Telephone: (fib, 013 <br /> Physical Address: d aa� oo �V 11 + � a- <br /> - - Mailing Address: <br /> E. DESCRIPTION ;I <br /> Type of Discharge: r <br /> i Volume: 5II <br />'4 Chemicals: Sb r r <br /> Circumstances: r` <br /> F. ACTION TAKEN y-J- � <br /> II� `li <br /> it r. <br /> h <br /> II� 11. <br /> SITE STATUS & II <br /> ij <br /> I <br /> E <br /> I EH 22 013 (Rev.4/91) <br /> Ji <br /> i <br />