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SAY .IOAQ(J`Pii COUNL TY <br /> YOTIFIC kTION OF H.AIARDOUS W 3STE DISC f*f COPY <br /> HE.-kLT11 & SAFETY CODE 25130.7 <br /> A. E.rERGENCY LEVE<- , <br /> ILII PHS-EHLOGTrcte one) <br /> B. S 0 URCE OF NFOR-MATION <br /> Name: r Cc.t�I 0 Phone:k") q(a 4 -3`/,qb <br /> Comnanv-_ Ab,16 i4 44�. 66� FI-14 <br /> Address: 30 q, IF, G✓P �r 4,� S` v c,le, 2 <br /> Designated Emplovee Name: al D Phone:_ d-Of -�(o <br /> Reporting Agency Name: Sj t <br /> Address: ;�v K F <br /> C. LOCATION AIN-0 DATE OF DISCKARGE <br /> Location: 2/ 57/ fc.v y 'l!, , GifGt-c <br /> (Ben Phvsicai Description) (City• or County) Circle one <br /> Date of Discharge: �t —G''�t`--fY <br /> Date uodned: �2/a 19 q Tune: <br /> D. RESPONSIBLE PEMONBUS NESS <br /> N arae of Business: s 4 e / I L G6-, �� IPS r.• Ivc G _ <br /> Contact Peron: Al rl / Phone: - Y 3 v // <br /> P`ivslcal Address:Mailing Address: .5G s '� <br /> E. DESCRiP'i MN <br /> T v-p e of Discharge: rvlz <br /> Volume: <br /> Caemicais: fisc <br /> C rcumsrmnces. <br /> SITE DLSPOSITION ,L 1.�, i� Iles��5 cc�?o� i�r l�_ •��t�ss c�c�ere <br /> � <br /> E:? 0 Ll- iRev. 03;:0/93) <br />