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3 <br /> SAN J'OAQUIN COUN'T'Y <br /> NOTIFICr PION OF HAZARDOUS W, ASTE DISirTARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL• I R III PHS-EH LOG # " a 1 <br /> cle One) <br /> B. SOURCE OF INFORMATION <br /> Name: EZ_ Phone: -_T 4� —z/4%8 <br /> Company: T v^1 s <br /> Address: 3 Z 11V OL- <br /> Designated <br /> Designated Employee Name: SN V Pf hone: !�7_0 <br /> Reporting A ency Name: 5,+Ir S'ap t led !� <br /> Address: 0 r c'3 9 ' SZv <br /> C. LOCATION AND DATE OF DISCHARGEd <br /> Location: <br /> (Best Physical Description) (City or County) Circle One <br /> Date of Discharge: UnI f a wAl <br /> Date Notified: �— --q _ Time: I $ O A}-M <br /> D. RESPONSIBLE PERSON/BUSINESS- <br /> Name <br /> ERSON/BUSINESSName of Business: � 1,47eW a I X-r4rGT F. <br /> Contact Person: L I Telephone: ( . q�L/ <br /> Physical Address: 11 EL, r` DR <br /> Mailing Address• <br /> .00 <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: —L ^J <br /> Chemicals; o �o e,4-,2b 0,,4S <br /> Circumstances:92 AJ <br /> nJ of <br /> ��rf� �� �t-�/ co .v rr�moi' �o•✓, , <br /> F. ACTION TAKEN /4� 40 •- r,: c✓1l'S ��'n/� <br /> ii ✓ / <br /> SITE DISPOSITION t 'e Z' r L1, 6e <br /> F vt, tr <br /> x <br /> V, r G i <br /> _ I <br /> EH 22 013 (Rev.4/91) <br />