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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVE L• I 11 <br /> III PHS-EH LOG #_ - A57 <br /> cle One) - <br /> B. SOURCE OF FORMATION <br /> Name: 0 Phone: (2- ) -7Z 5-ZU�'S l� <br /> Company: A T-nA)r n <br /> Address: 3 6- <br /> r GI + D <br /> Designated Employee N e: Phone: (� <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DIS HARGE <br /> Location: X33 S . yo_n � <br /> (Best Physical Description) �tyr County) Circle One <br /> Date of Discharge: _ L�/e4/S7 '] - - -- _ - — --— <br /> Date Notified: f3-10-qZ, Time: 3 :0-0 <br /> D. RESPONSIBLE PERS N/BUSINESS <br /> Name of Business: ,Je-t) {!`'+ryi LCL rujS _ _ <br /> Contact Person: -FScY, Telephone: 20 Lf L44 Z! <br /> Physical Address: c <br /> Mailing Address: Vo adoy, I�L:a �� Cp• �1 SZO __ . <br /> E. DESCRIPTION <br /> Type''of Discharge: V� 6U'r �' (USTI <br /> Volume: U/ny-r n„m .. <br /> Chemicals• <br /> -- <br /> Circumstances: i n <br /> F. ACTION TAKEN r e-�6VP <br /> ITE ' ISPOSITION 1441 <br /> ~�- /' -AA <br /> re t+ a-y-e <br /> EH 22 013 (Rev.4/91) <br />