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SAN JOAQUIN COUNTY s <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: © II III PHS-EH LOG # S 6 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name:_P r e sJ.o„ :Te s -f- Phone: LFUU) kyr <br /> Company:_ '7 c , k / <br /> Address: s /i k :e K u >-7 <br /> Designated Employee Name: o e- Phone: (zcxr) Ur F- 3 YY <br /> Reporting Agency Name: 77,77a, Ser✓ re <br /> Address: v­�- ,v. Cn <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: if-. �« �� °� LT / � cfc L C,q _ <br /> (Best Physical Description) 1City r County) Circle One <br /> Date of Discharge: Uvi <br /> Date Notified: / /s z Time: yA� <br /> D. RESPONSIBLE PERSON/BCISINESS <br /> Name of Business: _ y� <br /> 9��6 <br /> Contact Person: h Telephone: (1a) v6, s - s33 <br /> Physical Address: 4a 4 cl rw S -<oc/c-A0 C4 ,3� <br /> Mailing Address: A0 I o R suu-C SAH ,e u k„ Ag v re s c a u y <br /> E. DESCRIPTION <br /> Type of Discharge: t v u-1A 7 P <br /> Volume: <br /> Chemicals: <br /> Circumstances: j57-- <br /> F. <br /> n7-F. ACTION TAKEN 7 H �c s P L.eG) o c� lr��s } n u ✓ 4 iJ <br /> SIT/E� DISPOSITr!ION <br /> J�F-r�P v C <raa _ f lam .� fr- r r-s /... /• <br /> 41 <br /> r�ui�lwr S'e 1• a s ios rr..-e.�•L r..,r'l/ /z..,. , Pr rf:A,., /o C�P .:� it LL Lcue r Px 4.� <br /> EH 22 013 (Rev.4/91) <br />