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� - -V..J., —V1 ♦\ 1 a <br /> NOT'^ICATION OF 11ALA 2DOUS W� TE DISCHARGE <br /> HEALTH & SAFrl Y CODW180.7 <br /> A. EMERGENCY LEVEL: I 11 111 PHS-0-1 LOG <br /> (Circle One) <br /> D. SOURCE OF INFORMATI Np <br /> Original Source: ��r t ire �rn i f Telephone: �Vp' /70 <br /> Reporting Agency Name: <br /> Agency Contact: JG�ci r, Telephone: <br /> Address: <br /> C. LOCATION AND DATE OF D CI TARGE ff <br /> Location: �©c A'MAc- <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: 4 <br /> Date Notified: Z Time: <br /> D. RESPONSMLE PERSON/BUSINESS <br /> Name of Business U���m� O�/ �or✓/ �y ay`" to l`qZg I a, <br /> Contact Person: 7/;7 ,(Q-5 s Telephone: (y/_S1 Lys 76 T6 <br /> Physical Addrt Creek , �4 �r155E <br /> E. DESCRIPTION n <br /> Type Release: Si C<rr�lrv�lwG er nr�n �+,�a �G �Xe r d� lc wro n i�zY��h <br /> Volume: `'e ItS. <br /> Chemicals: . z r� �o ./P✓i. r��✓� .�?�'r�e�_ <br /> I. ACTION TAKEN <br /> II <br /> 1p P cs�� nv1 -I�wt -�p,� G'.�g reCr )I rte/ <br /> �� e �/1nrMnrl c-�e .,- c i �a �vri C PhGv <br /> 131-122 013 (Rev. 02/90) <br />