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SAN COUNTY <br /> NOTIFICATION OF JOHAZARDOUS WASTE DISCHARGI O pY <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVELGAI III PHS-EH LOG # —0 7 !Z <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: F Phone: (__j <br /> Company <br /> Address: <br /> Designated Employee Name: _ Phone: �) <br /> Reporting Agency Name: <br /> Address: 5c,,V ,E Awc,?zc,,0 -A 4 <br /> C. LOCATION AND D4TE OF DISCHARGE <br /> Location: BoZ. ( - fLr /i✓F• / Go�Z <br /> (Best Physical Description) i�r County) Circle One <br /> Date of Discharge: 19 <br /> Date Notified: 4/1 3¢�/A,� Time: tr- 54 Q 7 <br /> D. RESPONSIBLE PERSON/ USINESS <br /> Name of Business: e- .4cZ62F Y <br /> Contact Person: — Telephone: Czf- 2:34- -Z i -Z— <br /> Physical <br /> Physical Address: 0Z pl . CL-L" AV 0.a= c4 gsl�o <br /> Mailing Address: Z 14 , cL—,;Sc ~e- o4 -5�Z40 <br /> E. DESCRIPTION <br /> Type of Discharge: i� <br /> Volume: 3— io C--.1/6w s <br /> Chemicals: <br /> Circumstances l�7S' .CJS o��F�F/S Q'.ecCr <br /> F. ACTION TAKEN S/iGL uAs cLGvnIFt7 �f ��✓ fGceao rs.' <br /> SITE�STATUS <br /> EH 22 013 (Rev.4/91) <br />