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SAN <br /> OF HAZARDOUS <br /> COUNTY C0 P'f <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE 0 <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: II III PHS-EH LOG # C15 D 6 <br /> ( 1rcIe One) ' <br /> B. SOURCE OF INFORMATION <br /> Name: -F3eroie.) Phone: C2.OD 334 -ZIIZ <br /> Company: I eA re <br /> Address: Q <br /> Designated Employee Namb' Phone: (__) <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF D[ HARGE <br /> Location: OZ M 01 4Sm d / <br /> (Best Physical Description) ty r County) Circle One <br /> Date of Discharge: 4/j�9s <br /> Date Notified: — 4 9";-- Time:_ 'Srs ry <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: c <br /> Contact Person: -e, Telephone: -Zl <br /> Physical Address: k Of I <br /> Mailing Address: 5/A <br /> E. DESCRIPTION <br /> Type of Discharge: l)rcla-trv-rar i to <J- 01,22-n rl y-+ nrn.,v\cl <br /> Volume: <br /> Chemicals: 0?--6 <br /> Circumstances S�m�lnm�� Qn� Fvt rk <br /> r <br /> F. ACTION TAKEN AhS,,< O-n4- n.!/1 Qln r Y. y ha I rr� 'moi 1 r� r11n�c rl� f�i� <br /> Melt Prirt I Tri nhSr�hcn l- d /� �m r5nt"or/ �i r 1 r l/1� �(n coli n <br /> v I h <br /> co <br /> SITE DISPOSITION 0 h n <br /> EH 22 013 (Rev.4/91) <br />