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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 2SI80.7 <br /> A. EMERGENCY MPHS EH LOG <br /> qb -D � <br /> (Circle One) <br /> 8. SOURCE OF INFORMATION Phone: -, N69 <br /> Name: „! <br /> Company: <br /> Address: Phone: U <br /> Designated Employee Name: <br /> Repotting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DLSCHAR E <br /> Location: 5;' <br /> (Best Physical Des�ip 'on) (city or .Circle One <br /> Date of Discharge: <br /> Date Noafied: � S <br /> ' <br /> �. RESPONSIBLE PE. /BU SS <br /> Name of ® C , <br /> Contact Person;Physical Address: . <br /> yiauzng Address- <br /> DESCRIPTION <br /> Type of Discharg7c <br /> Volume: <br /> Chemicals: <br /> Circumstazzc� ca.o S .* ��� ®F ,��Zr�agy o.. 57 <br /> ACTION TARE�ii e± yr' ��' ®,�G6� ! ^rd� ' �®-.66 <br /> SITEE DISPOSITIONS •� ac <br /> !, G �+ rem <br /> EH 22 013 (Rev.4/91) <br />