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v /" <br /> AJOAQUIN <br /> NOTIFICATION OFHAZU <br /> HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180 . 7 <br /> A. EMERGENCY LEVEL:r <br /> � II III �i <br /> (Circle One) L/ HEALTH DISTRICT LOG q <br /> B• SOURCE OF INFORMATION <br /> Original Source: 4 e -Ilk <br /> t, Telephone: $-y=d <br /> Reporting Agency Name: �•T t • �. l� jF,f�; <br /> Agency Contact: ZBuu.P �' ,�fl� <br /> Telephone: ( J%c•s) YE� '_iY'1� <br /> Address : OAU. YC�'rr <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: _oiqu <br /> Date Notified: <br /> Time: fr:1L,j "Aq, <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business qr- 00 be4k,-,ec 41 <br /> Contact Person: aa6dawgY�^-cin' <br /> Telephone: (2-0a) S''��J-by/v <br /> Physical Address : <br /> E. DESCRIPTION ��// <br /> Type Release: &"GLH <br /> Volume: <br /> Chemicals: n <br /> F. ACTION TAKEN <br /> Z-� LIST,^ � e� + � <br /> tt/n,cti �t(_ Q M /S*c*L*C u 1��C1`•�t�Q /ttiiPVnn w2 <br /> J <br />