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SAN <br /> O <br /> D NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> D HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL II III PHS-EH LOG 9 3 D <br /> (Circle one) <br /> B. SOURCE OF INFORMATION <br /> �a(b M r.�Y Phone: (?" �-f 6 7- /O Oho <br /> Name: <br /> Company: AdvA ,Ea v+tel�cn <br /> Address: -. oe: <br /> ! g fAn 4 Phonb - 3yS <br /> Designated Employee Name: Du�A f3 .S <br /> Reporting Agency Name: S 4 - T 62LJA FY �n ufnrA n,'�til�'► N �, U� <br /> Address: opt w`(,'� <br /> CA <br /> C. LOCATION AND DATE OF DISCHARGE <br /> 5 . <br /> Location: <br /> Ci or County) Circle one <br /> (Best Physical Description) <br /> Date of Discharge: 1 ). 3 Time: ti <br /> Date Notified: o I I fe> 2- <br /> D. <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> qN DQ �b n �Pri <br />