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SAN JOAQUIN COUNTY <br /> ® NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> Health & Safety Code 4 25180.7 <br /> A. EMERGENCY LEVEL II III Health District Log / F " <br /> (Circle one) <br /> B. SOURCE OF INFORMATION <br /> Original Source Telephone: <br /> Reporting Agency LNa <br /> Agency Contact: Telephone: (,?��)Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Date(s): — 5f 7� Time: <br /> Location: <br /> • Best Physica script on (City or C u y <br /> ); D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: <br /> Contact Person: Telephone: <br /> Physical Address: 2 �� �' n <br /> E. DESCRIPTION <br /> Type Release: ���r <br /> Volume: <br /> Chemicals: <br /> F. ACTIO TAKEN <br />