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i <br /> SAN JOAQL N COUNTY ZARDOUSW:kSTEDiSCRAR UPI <br /> . - NOT <br /> IFICATION OF SA 25180.7 <br /> �,,. <br /> HEALTH &.SAFETY CODE 1 <br /> x PHS-EH LOG# <br /> A EMERGENCY LEVEL:,V II III 4 , <br /> u (Circle one) <br /> v <br /> B. ; SOURCE OF INFORMATION <br /> Phone: O <br /> Name: <br /> Company: Gk " ' <br /> Address: - S Z o <br /> Designated Employee Name: Phone: <br /> Reporting Agency Name: _ <br /> '' Address: <br /> C. LOCATION AND DATE OF DISCHARGE ' <br /> ' Location: "Z 2. 5 /1 -10 <br /> (Best Physical Descnption) City or County) Circle one <br /> Date,of Discharge: 2 <br /> Date Notified: a c L Time: <br /> D. �' RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: STo .u--t-ot'>> rT ��ZL G R - <br /> Contact Person: - Phone: ,t D` -�4/_-:Tr off• <br /> Phvsical Address: 4 -z- 1 S Z 1 <br /> Mailing address: 330 <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: iW CJA <br /> Chemicals: Yt'T%,Lot_kuvv,, b X s� rx,,4tr4 Rr�rUx, - � z nre -Q A A2 7 4- - <br /> Circumstances:-T--�j Inco aimVE 6Q F— [L, THS <br /> A)n COALcAZ)Wa/SZ��xS�F_�.anEQcL <br /> F_ ACTION TAKEN r+ -kc./A t c` <br /> SITE DISPOSITION_ i) r ALt,E-n Tu^ rte}n�TAy1n 22 Y F C) s rrt4r, <br /> F a <br /> 1 0` 1� <br /> i EH 22 013 (Rev. 08120/98) <br />