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SAti JOAQUI.EY C0U'.XTY ?'Y'NOTIFICATION OF HAZARDOUS WASTE DISCH. `� <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: 16 II III PHS-EH LOG��Q • Q�j �j <br /> (Circle one) <br /> B. SOURCE OF IINFOK.N.CATION <br /> Name: �L Phone: <br /> Comp y: <br /> Address: <br /> Designate Emplovee Na e: Phone: <br /> Reporting Agency dame: <br /> Address- <br /> 3o4 <br /> C. LOCATION AND ATE OF DISCHARGE <br /> Location: tb 5 ad', 0 , <br /> -f CX J-V\. <br /> (Best Physical Description) itv r County) Circle one <br /> Date of Discharge: Yl ny-tm.; <br /> Date Notified: Time:-- r 92a_ Qddd <br /> D. RESPONSIBLE PERSON/BUSINESS44 <br /> Name of Business: ["II N <br /> Contact Person: r"'01 VVwker Phone: 20�' - Lf ff LL 1) 3_ <br /> Physical address: - 0 <br /> Mailing Address: s 541ALm L6 ;5 <br /> E. DESCRIPTION <br /> Txpe of Discharge: J►10 rc,7�e� <br /> Volume: 26 K ri <br /> Chemicals: <br /> Circumstances: ri <br /> S �¢.fz�-oy c.A Oma- <br /> F. ACTION TAKEN, -- <br /> SI D SPOSMON70 <br /> • _ <br /> EH 22 013 (Rev. 03120193) <br />