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� u <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVELCI II III PHS-EH LOG k <br /> bl-0 - sa <br /> (L`ircle one) <br /> B. SOURCE OF INFORMATION <br /> X - / <br /> '- 6 - <br /> _ <br /> � DN Phone: (Z�I) � � n <br /> Name: r 1 { / S <br /> Company:_ <br /> 3a� _ / 'I W�6�2 Ai16, 3� (� 5��' c 952C)2 <br /> Designated Employee Name: Phone: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE 1 <br /> Location: <br /> g !� �,� hAMM� � 4AJC l 5-7'76167010 <br /> (Best Physical De/cnphon) (City or County) Circle one <br /> Date of Discharge: /Z000 <br /> Date Notified: ir/IA ZZ TimeIL r7ly" <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: V ICK ((�t� ' " <br /> Phone: <br /> Contact Person: <br /> Lp ( 5 �} <br /> Physical Address: 6N ! LI <br /> Mailing Address: q5 <br /> E. DESCRIPTION <br /> Type of Discharge:N VN v 0 L / 1 �� <br /> Volume: <br /> Chemicals: r , F/ T <br /> Circumstances: �- T <br /> �IE PJM1� 17 SlZAl�( e M2 i/��T�f t)MUtA icD �7 (rAST <br /> 03sc�vef) (2F1S sE7cP/NGz & I�(1VTo (�ACk <br /> gc;ul€cn1 Com <br /> F. ACTION TAKEN <br /> LA N-i 1ID DN h <br /> 1� (OMMc1J0% ")� /09JTALT/N1-i �/✓�IL IdTS �l �d�fIS �127S r/LEU <br /> SITE DISPSI ION ((JKI E Ill Ly jig ��CTI117 %O(A UU��S1Czf17 <br /> 0 VJ <br /> T N P INJEs.Tth617loju <br /> n' <br /> - < Jinl)S / J/�Llt� i�(/1O ?TD 1& f-J d HZ 'S <br /> i LL D <br /> �1Jto SH f �Fi McCftAr14SAA To <br /> oL/�i�-FI( i 1roc S '9 Z:01i'zo E, the PFAWRIAre <br /> D <br /> EH 22 013 (Rev. 08/20/98) ° <br />