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Awe SAN J'OAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: d) II PHS-EH LOG # <br /> C7 - a � <br /> (Circle One) <br /> B. SOURCE OF INFORMATION Telephone: ZQ°t 6fr- 339 <br /> Original Source: -7 R <br /> Reporting Agency Name: ?aC�ut�! o PUS�(U F-IF.r-It--7f-I 5E�2v1G� <br /> Agency Contact: 0Rk-T V N,� <br /> Telephone: Zva )_ L/{��j -3 3 : ._ <br /> Address: -414-5 N• SAS '10,4001M <br /> C. LOCATION AND DATE OF DISCHARGE 5-roe-KToril <br /> FRF. <br /> Location: 000f '-toLT - / - Ci or County) <br /> (Best Physical Description) ( r5' <br /> Date of Discharge: v KNOW' <br /> Date Notified: Time: 1 ;z)0 �, <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business <br /> CA L RVF• N C o . N <br /> Telephone: <br /> (2 ) 3 <br /> Contact Person: U1J � Tele p <br /> Physical Address: AREM61.4 <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: U !< DGS <br /> Chemicals: ?Ai bi- <br /> F. ACTION TAKEN <br /> �ii2T ��2 S!T SSSS cutGL. R v �G TD D i �N� <br /> �� v x�F1Y aF CoxfT` �hG�`�'/� •�S h�4 U rR� f3 S� <br /> 774,,—= 4P Aa <br /> EH 22 013 (Rev. 02/90) <br />