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AUJIFI'LION OF 1-IA7.ARDOUS WASTE DISCHARG]r (p - <br /> HEAL'1'1-I & SAFETY CODE : 80.7 <br /> A. EMERGENCY LEVEL. I 11 III <br /> (Circle One) PHS-EH LOG <br /> I3• SOURCE OF INFORMATION <br /> Original Source: l�r� r K,, u Telephone: <br /> Reporting Agency Name: S I �TOQ. 'ru��v f�NS— Z- <br /> Agency Contact: ci / �� l�e�v <br /> Telephone: air jf6 -3 Yam <br /> Address: /,f/' ge"'- O ff} l 9/Zl6.1l <br /> C. LOCATION AND DATE OF DISCI-IARGE <br /> Location: s?95 D , ' -,Ce ' -�,,,�c / 's I..� <br /> (Best Physical Description) (City oj�County) <br /> Date of Discharge: <br /> Date Notified: <br /> Time: <br /> D. RESPONSMIX Piz: SO /BUSINE-SS v <br /> Name of Business Cc. el <br /> G <br /> Contact Person: t Telephone: <br /> Physical Address: O <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: <br /> Chemicals <br /> F• ACTION TAKE �W <br /> 2 <br /> L <br /> " � L <br /> E1-I 22 013 (Rev. 02/90) <br />