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r" SAN JOAQUIN COUNTY <br /> NOTIFI�I'ION OF HAZARDOUS WASTE DI GE <br /> HEALTH & SAFETY CODE 25180.7 ^ ' <br /> A. EMERGENCY LEVEL: II III PHS-EH LOG # <br /> (C�rcle One) <br /> B. SOURCE OF INFORMATION 3 r -7-7 n <br /> Name: Phone: (�� <br /> Company: <br /> Address:— <br /> Designated Employee Name:G✓ �✓�'✓ 6Phone: Zin tf <br /> Reporting Agency Name: Al IC,b I CSS <br /> 3� <br /> Address: aa <br /> C. LOCATION AND DATE OF'DISCWGE 9�r <br /> Location:_ /9-7Z.:!T7 :;rnd;'z AZAye / <br /> (Best Physical Description) (City or ounty) Circle One <br /> Date of Discharge: <br /> Date Notified: /8 Time: d a <br /> D. RESPONSIBLE PERSON/BUSINESS �� �✓�� �i <br /> Name of Business: eA <br /> Contact Person: '�E[wb-7' Telephone: (2jp <br /> Physical Address: S -7-7 <br /> Mailing Address: 5 } <br /> E. DESCRIPTION <br /> Type of Discharge: U �_ -- <br />` Volume: �t k <br /> Chemicals: f c h v of ra p►� '' <br /> Circumstances: <br /> F. ACTION TAKEN e— dl, v2I <br /> S o // :2&, C Gras /-J I E— "7 <br /> /.} , -rb e�^ o I-e— <br /> SITE DISPOSITION- <br /> 61/ <br /> ISPOSITION <br /> rRe r'« <br /> , <br /> EH 22 013 (Rev.4/91) <br />