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0 SAN <br /> JOAQUIN COUNTY <br /> NOON OF • ii « <br /> . . 25180.7 rILE . COPY <br /> A. EMERGENCY LEVEL&[I M PHS-EH • <br /> (Circle One) <br /> SOURCE • INFORMATION <br /> Name: Phone: <br /> i ' • <br /> Address:- <br /> Designated <br /> EmployeePhone: <br /> Reporting Age. . . <br /> Address: <br /> C. • • _QF N <br /> Location:- <br /> , <br /> _ •• <br /> Date of • i •!�t� <br /> Date Notified: T1 !0 <br /> D. RESPONSIBLE - • <br /> Name of Business: <br /> � r <br /> Mailing Address: <br /> r <br /> a � <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Chemicals: kvl= is e <br /> r '. ■w a _r. A99:11 /tri •r. /1a>} <br /> F. AMION IAKEN <br /> /ice. 11 Lee <br /> Sff,DISPOSITION <br /> ��� � .fA-1 •� ILS ,I +��1.��,�� '� l <br /> EH 22 013 <br /> • <br />