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NOTIl---TION OF HA7.ARDOUS WAST- DISCHARGE <br /> HEALTH & SAFETY CODE 2S.�PO 7 <br /> A. EMERGENCY LEVEL H III PHS-EI-I LOG # <br /> (Circle One) <br /> B. SOURCE Or INFORMATION <br /> Original Source: _CAOf ly'S „� Telephone: (,�0 ) %?! 3i«/d <br /> Reporting Agency Name: <'—M" , Y11Jera Set,111res <br /> Agency Contact: ('kr,,,fes 1-f U Aj Telephone: 2d2 q6i? —3g%o <br /> Address: <br /> C. LOCATION AND DATE Or DISCHARGE <br /> Location: 100 N , co,� ad, / r kC4n j <br /> (Best Physical Description (City or County) <br /> Date of Discharge: <br /> Date Notified: '7716 �'p Time: 1 , 3 M <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business 710CC.- Co fe-.,- <br /> Contact Person: Plc-k- iJJ s Telephone: <br /> Physical Address: HDA w <br /> E. DESCR.IP'I'ION <br /> Type Release: <br /> Volume: (,/N����ry�•l <br /> r, <br /> Chemicals: 2� �C'1.lM� t-lrn /nl�an�t <br /> R ACTION TAKEN <br /> > t0-uerd retAw�ti <br /> S S pr .. 6y, b <br /> agoi�� <br /> EII 22 013 (Rev. 02/90) <br />