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. ... jlJllll UllV t-WU114 Y <br /> NOTYMCATIONyOF HA"LARDOUS WjWE- DISCHARGL <br /> I-IEAm-I & SAFcry CODL7180.7 <br /> A. EMERGENCY LEVEL: I H III PHS-EH LOG # 9 1 <br /> (Circle One) <br /> B- SOURCE OF INFORMATION <br /> Original Source: 0/,,, /,,�vro„r�cc� Tec Telephone: (LOR ) ,��Ov <br /> Reporting Agency Name: -- S4 11 `n omg n CC). P 4 S- (17 4 6 <br /> Agency Contact: _�� can ��� �� ��', � Telephone: z2=i ) y6p- 3 %5`/ <br /> Address: y`/ S 2z -S , Cg R n <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: y/&o l r��s�r � / / /�G✓I�ecs <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: <br /> Date Notified: - /���fD Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business x/'11 Ale rlf� 71f-�1169/ori 45 <br /> Contact Person: �'��, (��y,� Telephone: ( 5� 5 - <br /> Physical Address: - 3 S r�e 1 F r �� C ? So 5 y <br /> E. DESCRIPTION/ <br /> Type Release �iova���av �vrH/faG t /P �t�rl ,d a .mon /n�n5 �cl�s <br /> e <br /> Volume: 4 <br /> Chemicals: - 7 Al--melle <br /> F. ACTION TAKEN <br /> --PCS was r,/e, er114- <br /> e V-e( � e d,-, NI�Ia <br /> GoVPri1 ry <br /> EI-I 22 013 (Rev. 02/90) <br />