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SOFHAZARDOUS <br /> COUNTY <br /> 'if ILE COPY <br /> OTIFICATION OF gAZ?.RDOL'S WASTE DISCH.-1RG <br /> HEALTH, & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I II III PHS-EH LOG 03 - OZ3 <br /> (Circle one) <br /> B. SOURCE OF INFORMATION' <br /> Name: Phone: ( ) 40 -100 IR <br /> Company: 1tdv0,+nccd Loco Envlroylrv�arvtziQ <br /> Address: 4S 3-7 5 NA N/ 12d• S 1 DLktvri �I 5 215 <br /> Des ignatedEmploveeName: LD1r1GL Abort[ Phone: 2Dq• Htp%• 3 �� <br /> Reporting Agency Name: SAYI T_PL%tk.VI Cywvti _EnyIyanM1MtR Q Ftca 114�- <br /> Address: 0 E• VJe-YW2r 'j e' a>r d ppr 51-0 t_1_tr •, CA q"v 7- <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 1 b 3 3 �A^ 1 <br /> (Best Physical Description) itv r County) Circle one <br /> Date of Discharge: U)VL-�z ��3 <br /> Date Notified: 5-13-08 ` Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: \/AY1C0 TY k P�aZry VXy) AL p01 1✓i1 ict-Fr s-LS <br /> Contact Person: DAy ej A+ 0--1�' Phone. 2,09 . 4Iy5. -:5 12 I <br /> Phvsical Address: look W Chi,rtr."' yy" CA 0b;'o(o <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type ofDischarge: AASPl1n8 -DiC' ed <br /> Volume: <br /> Chemicals: <br /> Circumstances: -h'evtrh sus�rrryevnd�e�l aytdyuvV o1mn <br /> F. ACTION TAKEN <br /> SITE DISPOSITION <br /> EH 22 013 (Rev. 08/20/98) <br />