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SANN COUNTY ' M <br /> NOTIFICATION OF HAZARDOUS WASTE D[SCHARGECOpU <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG # <br /> ( ircle One) <br /> B. SOURCE OF INFORMATN <br /> N : c Phone: <br /> Name <br /> Company: <br /> Address: voZ <br /> Designated Employee Name: Phone: <br /> Reporting Agency Name:�c_��n T_�� �v. r r a� /04-t.� <br /> Address: L°/' <br /> C. LOCATION AND ATE OF DISCHARGE <br /> Location: -iw.r � -r in Jrv._u.-Ar <br /> (Best Aysical Description) i or County) Circle One <br /> Date of Discharge: <br /> Date Notified: S-Z� �5 —� Time: le"7 S �� <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: <br /> Contact Person: er Telephone: 71 <br /> Physical Address: <br /> Mailing Address: S <br /> E. DESCRIPTION <br /> Type of Discharge: _�Ac'J�/ Gf nc. dcm� 4uw� <br /> Volume: 30- <br /> Chemicals: <br /> O-Chemicals: <br /> Circumstances 2�. kA w" <br /> F. ACTION TAKEN R P aG& �- m '' i' ' " "� �a 1P °" <br /> F4 7" S a 0d <br /> /� srrCl h. _y 4.� oLL <br /> SITE STATUS l'I c- <4� o d A 6, R B Fes- 4- � 22t 1 <br /> s �a he e jqs�!-o <br /> EH 22 013 (Rev.4/91) <br />