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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: O II III PHS-EH LOG # `� <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: CHIF,�f (,�Jr�?�,—,�;_ Telephone. <br /> Reporting Agency Name: L`:af) 1r,AA)164 <br /> Agency Contact: r1c.CY fit,,_ _ Telephone: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: 'L 171 +'2rz <br /> c <br /> Date Notified: � � Time: n .0 --Z, <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business F ,-101-H - s A)212-ILP rJ fir) 71 .. <br /> Contact Person: 0 P {, )L: -p Telephone: <br /> Physical Address: -43-) <br /> E. DESCRIPTION <br /> Type Release: �� , �i��1 �1: �?�. �-�,r�;7 nl J.c % �` .< %,r v,' <br /> Volume: _L <br /> Chemicals: F'`-�e-�2 <br /> F. ACTION TAKEN <br /> / l �`` {� '? �/`~ /�r^1 ��^� ,('.'•9/{ fi /lam � <br /> EH 22 03 (Rev. 7/89) <br />