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SANN COUNTY_ J <br /> NO�IIFICATION OF HAZARDOUS WASTE DISCHARGECOPYHEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:1II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Q Phone: <br /> Company: <br /> Address: v <br /> Designated Employee Name: Phone: �) <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 602- Al - e,6-4�4 / zoAll <br /> (Best Physical Descripp ) � `/ l City or County) Circle One <br /> Date of Discharge: -a/2 (v P- Gc.,u <br /> Date Notified: 1 /4L7 95/ Time: d?30,-- <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: % <br /> Contact Person: T ephone: (2� - !/ J- <br /> Physical Address: FD 2 ,v. C- (�- <br /> Mailing Address: <br /> E. DESCRIPTION / , // • `/ <br /> Type of Discharge: __ Q� aL int Pz1 Qa�o � r.c��o i2e cr.8�i <br /> Volume: =.50 <br /> Chemicals: �:� e ( �c� <br /> Circumstances: ,z ,�c� ,LoC a�a�� a--- -1; e c <br /> F. ACTION TAKEN <br /> SITE DISPOSITION <br /> EH 22 013 (Rev.4/91) <br />