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1 <br /> SAN JOAQUIN COUNT , <br /> NOTI�.;ATION OF HAZARDOUS WAS�L DISCHARGE _ <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG # ,90 / 7y 7y <br /> cle One <br /> B. SOURCE OF INFORMATION <br /> Original Source: 01=�5 Telephone: ( 2,c)c) ) g <br /> Reporting Agency Name: <br /> Agency Contact: Telep one: ( 2nr, ) ..wog -3470 <br /> Address: <br /> i C. LOCATION AND DATE OF DISCHARGE <br /> Location: -25 �� I A). H�m or, t a,no / Sf-r,c <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: �- <br /> Date Notified: - 19t) Time: - " nrn <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business -QD►k SroP <br /> Contact Person: ,Igrk, 0%rrl : Telephone: (,�S (a c-5-1-R-ano <br /> Physical Address: <br /> E. DESCRIPTION <br /> Type Release:,-- 00?y Athno—ax-e l re leap <br /> Volume: 7C0 QniIm� <br /> Chemicals: i).L. C x-a-a I nv) <br /> F. ACTION TAKEN <br /> (1Inan up ctompr of/ W;I I SO law` ' a pa)pns-'li_-I f n f rmnye f 6/\P <br /> ha jI M Ott a ari-ik-d hhdz2x):3n t n <br /> r4sse-ceWen-r will Ioe- =ui rrct +n <br /> C� ✓rv1 i✓i u t-1nP nant ,e, -I-- e to n-- cnt n n f' ,�► r.af-' <br /> ria u 1 'rid b11 +120 aonrnnrt art- r�r.1AD Int <br /> EH 22 013 (Rev. 02/90) <br />