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NOT "CATION-6i '"-4 1-IA'LArtDOUS W. 'E DISCHARGE <br /> 1-IEA.LTl Y & SAFETY CODE 2S 180.7 <br /> A. RMERGENCY LEVEL: I II III PISS-EIS LOG # 7 <br /> (Circle One) <br /> B. <br /> SOURCE OF INFORMATION <br /> Original Source: (- R w CSC Telephone: (B6 00 - SG c)o <br /> Reporting Agency Name: <br /> Agency Contact: Telephone: <br /> Address: y � r r� <br /> Uc <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: I o„)(' 0I, �f/ 11 h) ' 9 / / <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: <br /> Date Notified: - T .�/-So 7 ' <br /> Time: -- ) • -) <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business v <br /> Contact Person: ;� Telephone: ( _) <br /> Physical Address: Z/C) <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: <br /> Chemicals: <br /> F. ACTIO/N TAKEN <br /> -- �'(�c✓rIY rr�.--� fir�.,�l /�S✓ /rP �'/c'c.r�,��s <br /> f47 <br /> 7z �] <br /> —"le (”ri� i y G14r'iJC y <br /> EH l� 013 (Rev. 02/90) <br />