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SAX .IOAQULN COU, T✓ �GS� <br /> NOTIFICATION OF UAZARDOUS WASTE DIS [E Copy <br /> E[EALTH & SAFETY CODE 2SI30.7 <br /> A. EMERGENCY LEVEL: I II PHS-EH LOG r <br /> (Circle one) <br /> B. SOURCE OF INFO UMATION <br /> Name: 4 Phone: (Z01 -TZ--o`0O <br /> Company: C� <br /> Address: 6015 <br /> Designated Employee Name: Phone: 4k A-M q F, <br /> Reporting Agency Marne: _STC_ ��Vr22C .Ln'1e ' 7 �-rr-fir;'fes <br /> Address: SOL-E <br /> C. LOCATION AXD DATE OF DISCHARGE <br /> LoGZuon:5iSi ALMO N Nkk=b D? _ t"ctiti Cit <br /> (Best Physical Description) ity r County) Circle one <br /> Dare of Discharge: <br /> Date Notified: Tune: <br /> 1 D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: DY _1L <br /> Contact Person: �':',t_L�A-�`Vl t - 2 t 4 Phone: 20 9 Z. b-f <br /> Phvsic3l Address: <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: ` G \ 1 f_N F <br /> Volume: <br /> Chemicals: <br /> Circumstances: <br /> F. ACTIONTAknINI , <br /> SITE DISPOSMON r <br /> EH 22 0 1; (Rev 03/30191) <br />