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SANAZARD COUNTY COPY <br />NOTIFICATION OF HAZARDOUS WASTE D[SCHARGE <br />HEALTH & SAFETY CODE 25180.7 <br />Aa EMERGENCY LEVELII III <br />ircle One) <br />B. SOURCE OF INFORMATI <br />Name P L �'iF <br />Company:! <br />Address: `=, <br />Designated Employee Na <br />Reporting Agency Name: <br />C. <br />D. <br />E. <br />F <br />LOCATION AND DATE OF D[SCFiARGE <br />(Best Physical <br />Date of Discharge: <br />Date Notified: I <br />RESPONSIBLE P <br />Name of Busines <br />Contact Person: <br />Physical Address <br />Mailing Address: <br />DESCRIPTION <br />Type of Discharge: _ <br />Volume: U N k <br />Chemicals: <br />circumstances: S. <br />PHS -EH LOG # / /4 <br />Phone: <br />Phone: <br />J.4� <br />(City or County) Circle One <br />EH 22 013 (ReV.4/91) <br />