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3AN JUAQWN C:UUN 1 Y <br /> NOT►FTCATION Or HAZARDOUS W/ 'E DISCI-TARGE <br /> 1-lEALT1-1 & SArM- CODL .80.7 <br /> A. EMERGENCY LEVEIL. I,/II III PHS-EH LOG # �2 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION _ <br /> Original Source: "/,, Telephone: <br /> Reporting Agency Name: N �2/44-1414 c_oI464--TA -<6,<VI<�45 <br /> Agency Contact: Telephone: 3459 <br /> Address: 4/N� IJ sQN `so.64vrN <br /> C. LOCATION AND DATE OF DISCI-TARGE <br /> Location: la!l !d- j6,eWqAY / STv6�vk �4 <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: VHKr�lOryrL <br /> Date Notified: !(fZ7 l/q RD Time: - y= z 7 ax, <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business F4WIL 5Anl6aGo 7PL-1�.eirl G- Th <br /> Contact Person: rA,4 N K 411`I&o6,i) Telephone: (z422�) 4��>' - S1,-7S <br /> Physical Address: -/'0/( Al• <br /> E. DESCRIPTION <br /> Type Release: -L144LITZ,1�91r4`0 h°E6d5esE ;_ "ll*at-27e <br /> Volume: �ilJKIlyuiN <br /> Chemicals: <br /> F. ACTION TAKEN <br /> IGF APS S!G/_V_ T_ T' i tv <br /> �D5Si6i � so,i � •�,uT,4�c�r�/�`TroFI FvRtrl�i2 s r ,4-sti�ss�/��LT <br /> Ly�i � /sr= fPEra��,�D -t-ri O�T�P rrJ �'-ifE IJQTDQE ANSI �>�!!-t' <br /> ar cnrlTA,utlYA�T-IoAj 4_6 A-oilRj�n r?V z-1-£F QoAer rE <br /> EI-122 013 (Rev. 02/90) <br />