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0 SAN JOA UIN COUNTY 0 <br /> NOTIFICATION OF HAZARDOUS WASTE DISCBFIU C 0 P Y <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: II III PHS-EH LOG T <br /> Pircle one) <br /> B. SOURCE OF INFORMATION <br /> Name: Phone:W) 42^Dgg.2 <br /> Companv: W YD <br /> Address: N. Wi C A cl 15,106 <br /> Designated Employee Name: 0 Phone: ' <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: IqQ I S. (51 PQV- ,0(Q <br /> (Best Physical Description) inDr County) Circle one <br /> Date of Discharge: UVA L40W V\ <br /> Date Notified: \7 - (o-c1 cA Time: 4:00 TM <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: a U ( IL ' N- &A <br /> Contact Person: aV G4Se-,M TkUV1 Phone: 20.1-521- 4G2"7 <br /> Physical Address: QQ(bi SiU C�k 85350 <br /> Mailing Address: SQ.VvU p S Qjco Je_ <br /> E. DESCRIPTION g / <br /> Type of Discharge: `rdyl1'1( ,IA.'�lUy i e-'e � <br /> Volume: 0M) <br /> Chemicals: <br /> Circumstan es: p OV0&M,t�Kafit7Y1 �a SGO✓P.�e �i I ��Q lM In <br /> ynyKoyalc, ware aMcU.Uzednnnd ✓r sin is s wbm Lf -ta Ett <br /> F. ACTION TAKEN r V1! -L,UP fbv, �G(rX 55e.SS W1P�Yl�-. <br /> yV�)Zx V_ Qd <br /> SITE DISPOSITION if <br /> V\ PJ,G <br /> 1 -LCPP <br /> EH 22 013 (Rev. 08/20/98) <br />