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.. 14we ff6�_ <br /> VOTIFICaTION OF gAyAgDOU$ WASTE DLSCHAR� <br /> ULALTH & SAFETY CODE 25180.7 <br /> 1LE COPY <br /> A. EMERGENCY LEVEL <br /> IIIPHS- LOG �7. 03� <br /> j ucle one) <br /> B. SOURCE OF li fFOR:NLATiO`r <br /> Name. Phone: iWA 571- G`'1 G U <br /> Companv� L <br /> Address 140 5t SAN m-"�r +--n <br /> Designated Emplovee Name: ?hane. <br /> Reporting Agency`Name: <br /> Address: <br /> C. LOCATION .i ND DATE OF DISCHARGE <br /> Locanon: �l ��ce (1'h <br /> (Best Physicai Descnpnon) r County)_Circie one <br /> Dare or Discharge: u '^ <br /> i une: <br /> Dace Notified: <br /> D. RESPONSIBLE PSMONlBUMNESS <br /> Name or Business: a r T!1 c- <br /> Const" Person: n r Be:Pho <br /> Phvsial address: 3 '� <br /> Mailing address: 1 + <br /> E. DESCRIPTION <br /> Type of DiSC'73r$er•r y <br /> Volume: <br /> Chemicals: 12 z <br /> Circumsmaces Q e u i aw c So SAM o le rz 2) D z" ✓ e <br /> nJ <br /> F. ACTION TAKEN la 5 i Q v.^nn� S (c <br /> SITE DISPOSITION J�'� Cn�- w� �'�+°^ 'l ` ( � �t <br /> w � u A-e- <br /> EH 22 0 l3 (Rev. =20/93) <br />