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AN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> (n MED <br /> II <br /> II <br /> A. EMERGENCY LEVEL(I) II III PHS-EH L I G #1 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> '���� <br /> Original Source: �' ► � ! ,. .� Tele hone' :• %�' ) � �� S'' �' f <br /> Reporting Agency Name: - S <br /> Agency Contact: % 1 Teleo,honeil (o ) <br /> I 'I <br /> Address: - 0 �� <br /> C. LOCATION AND DATE OF DISCHARGE <br /> J <br /> Location: Q E-. <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: <br /> Date Notified: <br /> c i <br /> Time:;l <br /> D. RESPONSIBLE PER ON/BUSINESS <br /> j c <br /> Name of Business <br /> Contact Person: .t%`rGGU, (Sand Tele one:l S: <br /> ' <br /> Physical Address: ��, 1 GL-:` L 5 .3 • <br /> H <br /> E. DESCRIPTION <br /> Type Release: c/ <br /> Volume: <br /> Chemicals: <br /> F. ACTION TAKEN <br /> na e� (&P Ijz, <br /> 42 4Y2� <br /> 3 <br /> EH 22 03 (Rev. 7189)Ala <br /> ��_ ►zc �C' � � II II <br /> I; <br /> II I e <br />