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SAN JOAlUN <br />COUNTY <br />NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br />HEALTH & SAFETY CODE 25180.7 ED <br />A. EMERGENCY LEVEL: On III PHS -EH LOG # <br />(Circle One) <br />�� • <br />A <br />E. <br />F <br />MOM <br />• .. - r►d► f+ '` a ��i/.�L%J��:u[I�/' �� '� r <br />a mail • - .u - <br />go <br />RESPONSIBLE PEI <br />Name of Business: <br />Contact Person. -.V <br />Physical Address: . <br />Mailing Address: _ <br />DESCRIPTION <br />,i - of Discharge: <br />Telephone: <br />EH 22 013 (Rev.4/91) <br />