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0_.,N JOAQUIN COUNTY U <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 { <br /> cp 11 111 PHS-EH LOG # <br /> A. EMERGENCY LEVEL: (Circle One) !, <br /> B. SOURCE OF INFq�RMATION <br /> Telephone: <br /> Original Source: (U&1 6!,-4 <br /> Reporting Agency Name: 1 r, i O I <br /> Agency Contact: ( C Telephone: _) �' `f <br /> Address: �. <br /> a C' <br /> C. LOCATION AND DATE OF ISCHARGE <br /> Location: / 3 ' i2 '&Z l Ci or County) <br /> (Best Physical Description) (City <br /> Date of Discharge: <br /> 2�zdY� <br /> G� Time: // -3 <br /> Date Notified: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business S / <br /> / r) Telephone: Vim/ <br /> Contact Person: LSC ` <br /> Physical Address. <br /> -� i S7 JGIC �y1 , <br /> E. DESCRIPTION = <br /> Type Release: <br /> ZZs <br /> Volume: <br /> Chemicals: <br /> F. ACTION TAKEN <br /> 111A '500 <br /> (1 )!JJ JG)0 rCL ✓VN� <br /> �7 <br /> c^c- ecY' 1,V- ,n7t . �Q <br /> " {�U • p t GUT; 2 �C( P r r <br /> 2 Ll �LCG ?Gh i �i �L�J% <br /> 2 <br /> EH 22 013 (Rev. 02/90) <br />