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_ w _ <br /> C. Q ERGENC i'ROI7 <br /> (Give name, address, telephone number, directions,distance and time estimate, and map.) <br /> Hospital: <br /> 11R#+trov a,, J. : 515 W. AC Lct- 265 rT -5S56 <br /> C 1.6tyw. r-9 S w Prril,lw Avc rr sd it <br /> eFww Its#' frac}� <br /> 14, p_.�g�.f <br /> rr,, ) eneeAe�aw llw L ,.te .rrf. <br /> 4 tN laf �� pIMYT cr . <br /> Other. <br /> D.�irASiE H R f`1'EitiSTiCS <br /> WastelContaminant Type(s): liquid [v] Sail[*1 Solid [] Sludge [j Gas [] <br /> Cbaractc•istic(s): (] Corrosive (X] Ignitable (j Radioactive <br /> (X] Volatile (X] Toldc (] Reactive <br /> (] Unknown [] Other(Name) <br /> Major Spills/RP—'Jases <br /> Release Contaminated <br /> Tune <br /> Date Chemie! Quantity Media* <br /> �e kncNti rdjcnicc <br /> (`air,surface water,sail, or ground water) <br /> Free Product: Yes [] Na [] ? Dissolved: Yes (J No (] 7 <br /> Have removal actions occurred:Yes [j No(,>' <br /> If Yes, describe: <br /> TIN <br /> General Facility Description: <br /> Gasoline Service Station <br /> Site Characterization: <br /> SF-9[}•1H1 0Page 4 <br />