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SAN JOAQUIN COUNTY <br /> NOTIFICA i'ION OF HAZARDOUS WASTE -,iSCHARGE <br /> HEALTH & SAFETY CODE 25180.7 Fly <br /> V <br /> A. EMERGENCY LEVEL: I II (III PHS-EH LOG # �3 8 <br /> (Circle Orie) <br /> B. SOURCE OF INFORMATION <br /> Original Source: Telephone: (—) <br /> Reporting Agency Name( <<� [11-6l041-0 <br /> Agency Contact: ,��2 Q Telephone: Z c (A ' 3` -z- <br /> Agency Contact: <br /> ,G, iSo Y LA <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location:/I(-/- /L1fa%( � <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: �-= -- <br /> Date Notified: Time: 62"' <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business CL o��: r�/t �3 -T-Ac, <br /> Contact Person: [2u< <br /> C- ,p vl• Telephone: ( Z vl <br /> Physical Address: '^ivc9'"' 64�' Q"'� �fleJ <br /> i <br /> E. DESCRIPTION <br /> Type Release: 1 i6L , w — <br /> Volume: Z- <br /> 61 <br /> Chemicals: <br /> F. ACTION TAKEN <br /> �O.,C4�Y+�-J•-� <br /> EH 22 013 (Rev. 02/90) <br />