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1 <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATI�ii OF HAZARDOUS WASTE DISt,�ARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Telephone: <br /> Original Source: _GovN'r`I F2�E pEP c^ <br /> Reporting Agency Name: <br /> Agency Contact: �R Telephone: 2�4 <br /> Address: S,4/N/ 75'`J <br /> C. LOCATION ANI D DATE OF DISCHARGE Gapes <br /> Location: D� �������� / <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: 30 <br /> Date Notified: 3� Tune. <br /> a:�a <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business <br /> Telephone: <br /> Contact Person: P <br /> Physical Address: <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: v�clvocvN <br /> ChemicAs: <br /> �yrcr��.s �u5 : Fi�E���GY �Q�Si°o�ISE <br /> F. ACTION TAKEN <br /> Cove <br /> Gf�Go�T E- GA-K <br /> EH 22 013 (Rev. 02/90) <br />