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SOF HAZARD COUNTY C <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE r J � r=✓ J <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: ' II III PHS-EH LOG # 613- 132 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: o - c� e Phone: <br /> Company: x- bc.� <br /> Address: es Gia r S <br /> Designated Employee Name:-42, <br /> Reporting Agency Name: S /J <br /> Address: P O , Ba>d -> o 2� S2` ca< 2s7-4/ <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: a OS /Y. <br /> (Best Physical Description) (City or ounty) Circle One <br /> Date of Discharge: 4,-1 93 <br /> Date Notified: //-- Time: <br /> D. RESPONSIBLE PERSON/BUSINESS 7- <br /> Name <br /> Name of Business: AAA /O/✓7 <br /> Contact Person: T --Z -T-7-/\/4F-"C Telephone: (?E` 91/ 8-6gag <br /> Physical Address: _-,7=o /-/, G�.v7�/L s7 S7o�1�0 ^. -9,S2d2 <br /> Mailing Address: P <br /> E. DESCRIPTION <br /> Type of Discharge: �h�L <br /> Volume: Gcha <br /> Chemical <br /> Circumstances: /^O ✓e- O <br /> F. ACTION TAKEN —77-7 e <br /> ->L 6s h ✓ iLC <br /> Ta S <br /> SITE DISPOSITION 4/2 C-� <br /> /e J (� <br /> aA Lso 6 <br /> L, d 4- <br /> EH 22 013 (Rev.4/91) <br />