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olux itt-LwU11`I l-VU1V1 I <br /> NOTIFIC` TON OF 1LA'LARDOUS WASTE ^TSCI-IAIZGE <br /> `._ALTH & SAFETY CODE 251,E <br /> A. EMERGENCY LEVEL I/ II III PHS-EH LOG # - Q�- 12* <br /> (Circle One) �/ <br /> B. SOURCE OF INFORMATION J <br /> Original Source: Pref I Si 01.1 116&54Y)�S Telephone: (209) q6 Z — 99// <br /> 2117 WVLl 8N. 5mckftn C� �1520(c <br /> Reporting Agency Name: <br /> AgencyContact: T 6my O I e-1* Telephone: (20g1 ) U68-3 q.68 <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 303 Z 5 . E 1 Do rctd o <br /> (Best Physical Description) (City o County) <br /> Date of Discharge: UfiAOWn <br /> Date Notified: 5 8 8 Time: UnKrrawn <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business 2 U 1 K --Frar),�2or45+)6n <br /> Contact Person: IO-K 17f-5ChO le-S Telephone: (�n q106 -0L181 <br /> Physical Address: 30:32 '5 , E I 0C)rad Si- c� k� C�SZb6 <br /> E. DESCRIPTION T' G' Box (oo(b S+Kn , 15152-66 <br /> Type Release: — Cl d e-A �1'eClSl b Yl ��5� <br /> Volume: -- U n <br /> Chemicals: 'D i e ui <br /> F. ACTION TAKEN <br /> resu 1 +-, 2 C r tr). <br /> T r ,5se-SS rn <br /> r uoi II 1� w k reA m <br /> -r� hrPL Y-e. a-m/1 X m,4 o� CF n+A/YYD ) n cJ , az, r-e <br /> EI-I 22 013 (Rev. 02/90) <br />