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SAN JOAQUIN COUNTY .r <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 F jL E Copy <br /> A. EMERGENCY LEE/EL: I II III PHS-EH LOG (O 0 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: Cdd9)7!07- 3 7n <br /> Company: <br /> Address: C <br /> Designated Employee Name: L fr f,. _ R,11 Phone: 4.6 St <br /> Repotting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISC:-TARGE <br /> Location: k9& D ul s f' Gt) .� <br /> (Best Physical Des baon) (City o gamy Circle One <br /> Date of Discharge: <br /> Date Notified: — <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: i�-rmta,q n( �,4 epi <br /> Contact Person:- Telephone (moi 'T rt'f-d 7oz0 <br /> Physical Address: <br /> �.ryr�l ��1 T <br /> Mailing Address: S',Z� a-.oob-cv e <br /> E. DESCRIPTION ' ' 1 <br /> Type of Discharge: <br /> Volume,- <br /> Chemicals: <br /> olume,Chemicals <br /> Circumstances: s , <br /> F. ACTION TAB74N ` <br /> SITE DISPOSl'%ON <br /> EH 22 013 (Rev.4/91) <br />