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MOTIF•TION H <br /> OF AZARDOUSS WASTE DI CEL L E COPY <br /> HEALTH & SAFETY CODE 2:5180.7 <br /> A. E`IERGENCY LEVEL: I II 111 PHS-EH LOG Q f — (DJ 1 <br /> (Circle one) <br /> B. SOURCE OF NFOR.MATION <br /> Name: <br /> c Phone: (.2D ) �o � g/ <br /> LE'�h t3 Tp (� i G �' �� <br /> Company: <br /> Address: _ <br /> Designated Employee Name: Phone: c� <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCILaRGE <br /> Location: '{ D 7 UMtlob <br /> (Best Physical Descnpuon) (City o County Circle one <br /> Date of Discharge: : DO <br /> Time. <br /> Date Notified: — — <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: <br /> Contact Person: 9 Phone: ( R69) _ D_ <br /> Phvsical Address <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: 66"q <br /> Volume: a4"147 G'w <br /> Chemicals: 1 pif7 <br /> Circumstances: <br /> 44 <br /> reviCtU0 <br /> F. ACTION T.aKEN G7/i <br /> SITE DISPOSITION <br /> c <br /> to <br /> EH 22 013 (Rev. 03/20/93) <br />