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J UAQ U1N COUNTY <br /> NOTIJWTION OF lIAZARDOUS WAS DIS <br /> �� HEALTH & SAFETY CODE 25180.7 <br /> J U L 16 199r <br /> A. EMERGENCY LEVE : I Ai IIIENVIROl NT <br /> (Circle One) PHS-EH LOG # ,�.I- ,,,,,�_ <br /> B. SOURCE OF INFORMATION <br /> Original Source: <br /> Telephone: <br /> Reporting Agency Name: N IN <br /> Agency Contact: ��►c.�r/,� -��,�,,y-�— Telephone: <br /> Address: t_,/ _ r / �N (7 j <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location:: . c _ <br /> (Best Physical Descrip ,on <br /> (City or County) <br /> Date of Discharge: N4c c% <br /> Date Notified: 6 <br /> Time: <br /> D• RESPONSIBLE PERSON/BUSINrSS <br /> Name of Business S'S <br /> Contact Person: P-5 Telephone: �" ("� 0 <br /> Physical Address: <br /> E. DESCRIPTION <br /> 'lope Release: <br /> Volume: <br /> Chemicals: <br /> r• ACTION TAKEN ` <br /> 60 <br /> EH 22 013 (Rev. 02/90) <br />