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�AN jOAQUIN COUNTY F H �RGE-_ <br /> ' <br /> OUS WASTED <br /> OTIFICATION O � Ty CODE 25180.7 <br /> N HEALTH & SAF = <br /> 11 1II PHS-EH LOG # <br /> A. EMERGENCY LEVEL: (Circle One) <br /> B. <br /> Telephone: <br /> SOURCE OF INFORMATION <br /> Original Source: i <br /> phone: <br /> Reporting Ag <br /> Agency Contact: <br /> Address: <br /> D DATE OF DISCHARGE' Lo <br /> LOCATION AN <br /> C. <br /> at ��[' �� (City or County) <br /> Location: isal Description) <br /> (Best Phy•s <br /> t) <br /> Date of Discharge: Time: <br /> Z� <br /> Date Notified: BUSINESS <br /> D RESPONSIBLE PERSON/ <br /> Name of Business SM Telephone:Coffcj <br /> Contact Person: <br /> Physical Address: <br /> E, DESCRIPTION <br /> Type Release: <br /> U <br /> Volume: <br /> Chemicals:F. r <br /> ACTON TAKEN ` <br /> i <br /> EH 22 013 (Rev. 02/90) <br />