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0 14 <br />SAN JOAQUIN COUNTY <br />NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br />HEALTH & SAFETY CODE 25180.7 <br />A. EMERGENCY LEVEQ,ircle <br />II III <br />one) <br />B. SOURCE OF INFORMATION <br />Company, Lt,1A-4 V J SZ� <br />Address: a,^71L4 1 n\jGpCjLe, <br />Designated Employee Name: <br />Reporting Agency Name: <br />Address: r <br />PHS -EH LOG # <br />Phone: (40 30A -307.7 <br />C. LOCATION AND DATE OF DISCHARGE <br />Location: "701NO IJ e1 R ) OCL) S��E / 5 4 <br />(Best Physical Description) ((City)r County) Circle one <br />Date of Discharge: 1AA1,61, iXII <br />Date Notified: ? 'GiGI C.j Time: Li L <br />D. RESPONSIBLE PERSON/BUSINESS <br />E. <br />F <br />Name of Busine <br />Contact Person: <br />Physical Addre: <br />Mailing Addres <br />DESCRIPTION <br />Type of Discharge: <br />Re <br />ACTION TAKEN l` e It -4',-,c C- ' Vt LLA i -L o (-L"- fg vd 4 if <br />EH 22 013 (Rev. 08/20/98) <br />