Laserfiche WebLink
SAN COUNTY <br /> NOTIFICATION OF HAZQARDO S WASTE DISCHARG " I L E COPY <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL( <br /> it II III <br /> PHS-EH LOGY 01 - 022, <br /> ircle one) <br /> B. SOURCE OF INFORMATION <br /> hone: 9o% '"' <br /> Name: / 'r �— <br /> Company:: C,� cyL <br /> Address: Phone: 2 <br /> Designated Employee Name: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> AI a-1 L . , ..�.... ) �Stti�. l c5 G <br /> Location: / (Cin r County) Circle one <br /> (Best Physical Description) <br /> Date of Discharge: Timz: l l`)r f��Ryr� <br /> Date Notified: <br /> D. RESPONSIBLE PERSOWBUSINESS <br /> 'eS <br /> Name of Business: 1 Y1 <br /> Contact Person: <br /> Physical Address: / _ U e- <br /> Mailing Address: S-fG C-,4 oGK•+e�� g5R,07 <br /> E. DESCRIPTION / (, <br /> Type of Discharge: <br /> Volume: LL�Ip�yz <br /> Chemicals: Q <br /> Circumstances: u <br /> F. TION A TION TAKE <br /> SITED SPOSIT N <br /> EH 22 013 (Rev. 08/20/98) <br />