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SANJAZARD COUNTY \ o <br /> NOTIFIC.,�'TION OF HAZARDOUS WASTE DISCriARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL II III PHS-EH LOG # C? 1 J c 2 <br /> Circle One) <br /> B. SOURCE OF.INFORM��ION <br /> Name: C¢�- -Ha. I^tE5C Lt� Phone: �f�Ste— U3�/ <br /> Company: <br /> Address: <br /> Designated Employee Name: Phone: 90q i//ef-3 Yj <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 37 ,6_S Wp c; X A,71,Y / K <br /> (Best Physical Description) Cit or County) Circle One <br /> Date of Discharge: <br /> Date Notified: 7-30 — f/ <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: hG. <br /> Contact Person: ^ G Telephon� ja Sa—S: / <br /> Physical Address: <br /> Mailing Address: <br /> E. DESCRIPTION c <br /> Type of Discharge: Oti6t .&OW ANY, <br /> Volume: <br /> Chemicals: <br /> Circumstances: i14 ly <br /> `o <br /> e v <br /> F. ACTION TAKEN <br /> SITE DISPOSITION — <br /> � <br /> tU ' t / <br /> l <br /> EH 22 013 (Rev.4/91) <br />