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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE _ <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: Qcle <br /> 11 III PHS-EH LOG # <br /> One) <br /> B. SOURCE OF INFORMATION J <br /> Original Source: :h ex— 6,0 Telephone: (c�0� )Ykf.'35127 ! <br /> Reporting Agency Name: <br /> Agency Contact: Telephone: R0 9 ) t(oP=`�V37 i <br /> Address: f, <br /> C. LOCATION AND DATE OF DISCHAR E S Q <br /> Location: 13 <br /> (Best Physical Description) (City or Co nty) <br /> Date of Discharge: <br /> Date Notified: —6A— 9 Time: 0��, --D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business r Q <br /> Contact Person: Fred P z ,j u, Telephone: <br /> Physical Address: <br /> e ;~ <br /> E. DESCRIPTION :M�� -1 33 <br /> Type Release: <br /> Volume: <br /> Chemicals: <br /> F. ACTION TAKEN <br /> � r <br /> -44 21 <br /> 67 <br /> C ' <br /> � T <br /> S S <br /> T <br /> EH 22 013 (Rev. 02/90) <br />