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STATE WATER RESOURCES CONTROL BOARD NOTIFICATION Form TO COUNTIES OF HAZARDOUS WASTE DISCHARGE <br />SAFE DRINKING WATER AND TOXIC ENFORCEMENT ACT OF 1968, PROPOSTION 65 ._ <br />SECTION I: PRELIMINARY NOTIFICATION DECISION' <br />1. DOES THE DISCHARGE MEET ALL FIVE OF THE PREREQUISITES? 2. DATE: 3. TIML <br />CO -I - 13 DYES • NO <br />4. STATE OR REGIONAL BOARD OFFICE . <br />..->GI.cs-c••• i--4-\ ei-v4-0 i (:4-4-icirvo Cordicoc-- <br />5. PROGRAM (e.g. UST, DoD, NPDES, other): <br />:------.._.-- rii <br />SECTION II: DISCHARGE INFORMATION <br />1. DATE OF DISCHARGE: _ <br />2. DISCHARGE TYPE: <br />HOW DISCHARGE DISCOVERED: <br />do Nr\e Op ,-.c_ (,..›.e._.1/4,k sar,p1 ; rvi <br />REPORTING SOURCE <br />..ta %V 6. ) STE 2-00 <br />I c ii:\ 50 <br />PROBABLE DISCHARGER <br />5 erz..i ICES <br />5. iNessiv,3 C-r-, <br />-c-,cps; c A qz 3••••?,_ <br />NAME: C es,--rf?,4%-.. ‘.) rao....e9 4,.....1A-reix- 13cAT2. <br />STREET ADDRESS: i tOZO Suid Celt <br />CITY/STATE/ZIP CODE: 12.14.....1a44-0 CO ro...bcp....10.... <br />EMAIL: <br />PHONE: (citti, w o q _ .3Dnik <br />NAME: --1..R..A - PC..r <br />STREET ADDRESS: ....4":-4. <br />CITY/STATE/ZIP CODE: (.4\04.,z <br />EMAIL: <br />PHONE: <br />DISCHARGE LOCATION <br />gS 33-* <br />-12.t.2k'Sr÷ <br />DESCRIPTION OF DISCHARGE <br />pot5-4-- t)esit_z c <br />iivitut_ re_s4...114-ed <br />as rtki-e-k et-k b" <br />ac,r,Ne At.... c_ (..,...w.At <br />INCIDENT: <br />i de use- ar.ciloc- icrasc NAME: rt\prenro f2e:Ts 1 t)G t-ir-E; <br />ADDRESS: -a_k k -2._ , orsek it..__N '47:-. <br />CITY/COUNTY/STATE/ZIP CODE; PA,A,p...rrE=CA I CA <br />PHONE: ,._?oci) LIS - ,Doqci <br />GIS LOCATION: Latitude .31 .1414411.- Longitude <br />r- %, N OD L/ Nill Li-sc's4 I rvIc•-c--it S * <br />-J s el P.A. 0.1 %--) -4-1/4-e_. iscls A-c- <br />MONITORING INFORMATION <br />8 CHEMICAL NAME 9. VOLUME, MASS AND UNITS OF THE CHEMICAL 10. MEDIA TYPE (AIR, WATER, SOIL) <br />tit. "B -_F.* etne ("1-c,A1 ", , t S Qs 1 L rio ...I r \ ...-P•-(1 -j- <br />'The discharge discharge incident must meet all five of the prerequisite listed in the instruction sheet. If all five prerequisites are met, this starts the 72 hour county <br />notification clock. See instructions for more information. <br />2/6/2015