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SAN JOAQUIN COUNTY <br /> i NOTIFITION OF HAZARDOUS WASTE D :I-L4RGE <br /> HEALTH & SAFETY CODE 25180.7 � py <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG #---'Z" <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> -� y y <br /> Name: J-�-+N 4'71 1 C 1 m C-m _ .. - -- Phone: 7�` <br /> Company: S" <br /> Address: 4 z�r t.:� '" CV•. <br /> Designated Employee Name: , Phone: — <br /> Reporting Agency Name: Tv <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: /?�z ,2�� 2 .kf s� /,./ / <br /> (Best Physical Description) (City or County)-t' cle One <br /> Date of Discharge: \ ICV,.,nit� r1j _ <br /> E <br /> Date Notified: Time: <br /> jD. RESPONSIBLE PE. N/BUS, NESS <br /> Name of Business: A— ki 2k• 6—L' l— Cru <br /> ('S <br /> Contact Person: :T E 6 Telephone: -z- <br /> Physical <br /> Physical Address: 14t, a <br /> Mailing Address: Gam` alb <br /> i <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: t ry IC <br /> Chemicals: 4 <br /> Circum stances: <br /> F. ACTION TAKEN Z61,9eq <br /> I <br /> I <br /> c <br /> E <br /> I SITE DISPOSITION <br /> tc ref <br /> r 12 r 1 <br /> f <br /> EH 22 013 (Rev.4/91) <br /> i <br />