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SSAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:�II III EH LOG # C)3 D 3 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: <br /> Company: a.cT <br /> Address: <br /> Designated Employee Name: Phone: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE / �-- <br /> Location: �) i r C ty) Circle One <br /> (Best Physical Descriptio <br /> Date of Discharge: 6z-v--A, <br /> Time: <br /> Date Notified: 6 2-2(— <br /> D. RESPONSIBLE PERSON/BUSINESS �y <br /> Name of Business: C.d <br /> Contact Person: Telephone: -3-57—--52,zZ <br /> Physical Address: <br /> Mailing Address: 17 5 tri lZ� <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: -ter <br /> Chemicals: GE a <br /> Circu tances: .9 <br /> F. ACTION TAKEN <br /> SITE DISPOSITION d� <br /> EH 22 013 (Rev.4/91) <br />