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SAN HCOUNTY <br /> NOTIFWION OF HAZARDOUS WASTE D*3ARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL�ti III PHS-EH LOG # ��d3 <br /> ( ircle One) <br /> B. SOURCE OF INFORMATION <br /> Name: Scgt,If_ jA�/r- Phone: (2L�) s3s�- 3,0 7 <br /> Company: cy�i F€ c���C c o1CP - <br /> Address: (`71-0 A(A-:c:V4>z D <br /> Designated Employee Name: Phone: o�) VbS-3422 <br /> Reporting Agency Name: <br /> Address: V'W5 Al si{ 30 [7 TL S/ S-r: f- 7zr rJ 6,4 <br /> 9Ci zap <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 7420 e-11-7AIPKI�4— PC)- / L- <br /> (Best Physical Description)/ �r County) Circle One <br /> Date of Discharge: VGA <br /> Date Notified: Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: <br /> Contact Person: 4:-A01c, /740ii 61-4-7zn/ Telephone: (tut ) f6-t - �41 <br /> Physical Address: Zoyo 'rk WE2 ?-C46 GaD2 <br /> Mailing Address: 0c�x 3007 /�aT G� gSp�/ - /tea <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: <br /> Chemicals: <br /> Circumstances: <br /> F. ACTION TAKEN vN0 -GP�c�/DR�G��i9rVK5 �vf�E ovFp <br /> l� 9/ <br /> SITE DISPOSITION r— �onJ7/tv'r lNr�Troh�tUIGG f%E �vCUh�N � <br /> EH 22 013 (Rev.4/91) <br />