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SAN JAN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAF1 TY COOL 2518U .7 <br /> A. EMERGENCY LEVEL: / I / II III IILAL'1'N DISTRICT LOG II <br /> (Circle one) <br /> B. SOURCE OF INFORMATION <br /> 2 <br /> Original Source: �`"�t�� <br /> 9 iC�rLvi v�1 ��(9-a t/"(I�rar��Q !'�vi�I e lephone: 1(�qLv, <br /> Reporting Agency Name: ao, Jmqu'✓l L za k He 441 I�crr« f <br /> Agency Contact: bgr-y: urn� ,i-. . _ Telephone: (2,2,c'� ) V& ''-3cla-d <br /> Address: I IQI F. !-I <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 115 1, ) Ek(n-fAT M Lc <br /> (Best- Physical Description ) (City of County) <br /> Date of Discharge: �i-Ib u3 <br /> Date Notified: —���� Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business ; <br /> Contact Person: 1LI'jkk CAV- )jjJ e . 'Telephone: (moi) 51 -� <br /> Physical Address : 11153D W. <br /> E. DESCRIPTION <br /> Type Release: J,LkVLL(fl1.(:,,1-A- ! <br /> Volume: ( ;n�.k� LoO—Y-� <br /> Chemicals: i) <br /> F. ACTION TAKEN <br /> 1;-ir-Hu,1 Sifiv <br /> ry,r.t re PXt: Y ��t/l vt-�,nf. itilc l n roc i mil tf�! <br />