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Q <br /> SAN JOA UIN COUNTy FILE C <br /> US WASTE <br /> NOTIFICATION OF & ,I,O CODE 2 80.7SC$�GE <br /> HEALTH <br /> A. EMERGENCY LEVEL: I II III <br /> PHS-EH LOG M <br /> (Circle one) <br /> B. SOURCE OF INFORMATION <br /> ('l d o 'u 5 Phone: ((b%)m `^ 1 e6� (62 0 <br /> Nae: A ck i� ' ' <br /> Company. c.R <br /> 10 2`� <br /> Address: Phone: (l dog- 4$`M <br /> Designated Employee Name: <br /> Reporting Agencv Name: i-L- ,. q <br /> Address: W� <br /> C. LOCATION AND DATE OF DISCHARGE C <br /> Location: itv r County) Circle one <br /> (Best Physical Descnption) <br /> Date of Discharge: Time: L AV%,--- <br /> Date Notified: <br /> D RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: Phone:-q <br /> Contact Person: <br /> •.��D d L( Q <br /> Phvsical Address: �(ocf D C <br /> Mailing Address:]o 3© <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: <br /> Chemicals: <br /> Circumstances: <br /> It 0 <br /> ----------- <br /> F. ACTION TAKEN <br /> SITE DISPOSITION b <br /> EH 22 013 (Rev. 08/20/93) <br />