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OA <br /> NTY <br /> NOTIFICATIONAOFJHA4ARDOUSUWASTE DISC <br /> HEALTH & SAFETY CODE 25180. 7 <br /> HARGE <br /> A. EMERGENCY LEVEL: <br /> oPEAL _ <br /> (Circle One I - II III <br /> DISTRICT <br /> LOG # <br /> B• SOURCE OF INFORMATION <br /> Original Source: <br /> Telephone: 45 ) <br /> Reporting Agency Name: <br /> Agency Contact: <br /> Telephone: ( ) �.���2"U <br /> Address: RU, j�� ;do <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: /,2 5• /� / r <br /> (Best Physical s <br /> Description) <br /> Date of Discharge: (City or County) <br /> Date Notified: 0 ' <br /> Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business Z,041 ��wd <br /> Contact Person: 44-�nm Telephone. ' <br /> Physical Address : /0'23P <br /> Cti tw_ <br /> E. DESCRIPTION <br /> Type Release: �l "Adz-" <br /> Volume: <br /> Chemicals: <br /> F. ACTION TAKEN <br /> r�;t <br />