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HAZARDOUS WASTE <br /> ` MANAGEMENT REPORT ..� <br /> State o f California 4250 Power Inn Rd.,S■rn*e++to 95826 <br /> (916)739-3145 <br /> Department of Health Services 5545 E. Shields ave,Fresno 93727 <br /> (209)291-6676 <br /> 5850 Shelimound,Emeryville 95608 <br /> �� 171, q <br /> (415) 540-2043 <br /> Dat0 107 S. Broadway,Los Angeles 90012 <br /> (213)620-2380 <br /> Firm Name /'�X/ N T <br /> Address /6/2 7G1,� <br /> L.Gr01— <br /> /.'rte EPA I.D. Na. / "O �J -- — <br /> T <br /> Person Interviewed �Oa , /Y p <br /> The following conditions or practices observed this date are alleged to be violations of one or more sections of the <br /> California Health and Safety Code, Division 20, or the California Administrative Code, Title 22, relating to the <br /> storage, handling, transportation, and disposal of hazardous and extremely hazardous waste or asbestos containing <br /> products. The inspection and the collection of samples or other evidence, including the taking of photographs, was <br /> conducted under authority of Section 25185, California Health and Safety Code and Section 66328, California <br /> Administrative Code. <br /> a) <br /> Your signature acknowledges receipt of a copy of this report and collection of any samples described above. <br /> Authorized Representative of Firm <br /> Name C� G� Auth ed Agen <br /> EHPage 4 of <br />