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07/21/95 F 14:2.1 FAX 12094673839 POSDEF POWER Q007 <br /> SAN JQUIW COUNTY IFIIF py <br /> NOTCATON OHAZARDOUS WASTE DISCGHARE //-10 <br /> HEALTH & SAFETY CODE 25180.7 <br /> C�3 <br /> kgildYNCY LEVEL: 1) 11 [if PHS-EH LOG #---- Ll <br /> (92rde One) <br /> B. SOURCE OF INFORMATION <br /> Name: boxkA Phone: <br /> of <br /> comp <br /> A <br /> Address: <br /> Designated Employee Name: Phone: <br /> Reporting Agency Name: <br /> Address:. <br /> C. LOCATION AND DATE OF DISCHARGE e t7o,- <br /> Location: D�'S�2-& f,�Z� "S k!��_ / ')-to C-4- <br /> (Best Physical DescriptionY (City or County) Circle One <br /> Date of Discharge: -111(olir <br /> Date Notiffied: Time: -?-6oA,,A <br /> D. RESPONSIBLE PE BU NESS <br /> Name of Business: W-7 -3? <br /> Contact Person: 'S4, Telephone: (LOD ---- <br /> Physical Address: - 2V;2,G <br /> Mailing Address: :1.� 6LJ. Idt< <br /> E. DESCRIPTION <br /> Type of Discharge- <br /> 0 <br /> Volume: OJ--WCP <br /> Ch <br /> s:emical so <br /> Cir curwtances: �aL <br /> F. ACTRON TAKENJ"_&4-AAY��- . <br /> S[TE STATUS <br /> EH 22 013 (Rm4/91) <br />