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NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br />Health & Safety Code § 25180.7 1 0gQ <br />CooENVtR®MENTAL HEALTH <br />ERM1-� /SERVICES <br />A. SOURCE OF INFORMATION <br />Company Name: / j R <br />Contact Person: <br />Address: c/o/D 4)ES - g4j <br />Telephone: hZay� 3.33 <br />B. LOCATION AND DATE OF DISCHARGE <br />J�1_ 6.. a .. .. - .• . .. <br />Date:....®_. 1— Time. - <br />r <br />Location: uTh/- e41 <br />st-Physical Description-),ty or County),. -.w <br />C. RESPONSIBLE PERSON/COMPANY: <br />Name of Company: C0f},57" d�}y{'�,eS (�,4ri,1 b!(%!S /d Aj <br />Contact Person: 4, ICtt � <br />Physical Address: • <br />Y $�yTt� �.t dc{�Tc�K� �T � l <br />Telephone: 6LO'7) 33 ie-4zw/ <br />D. DESCRIPTION <br />Type ,A ,,� <br />;. i r <br />Chemicals: 4 a , - <br />W <br />