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SAN JOA UIlV <br /> . NOTIFICATION OF Q COUNTY "��"•�'u _ �_ , ' . <br /> hEALTH & SA4RDOUS WASTE DISCHARGE . <br /> FE'zY.CODE 25180.7 <br /> EMERGENCY LEVEL: I IID1 , . <br /> PHS-EH.LOG .. <br /> B• SOURCE OF WFORMA770N <br /> Company; l <br /> Address: , ,Phone: jj <br /> tY <br /> Designated my <br /> Name:Reportin Agency Name: <br /> ' <br /> Pho <br /> ne: <br /> Address: <br /> C- LOCATION AND DATE OF DISCHARGE - <br /> Location: A • 3 - A <br /> (Best Physical Desn) <br /> oll <br /> - 01 <br /> Dane of clipua <br /> charge: ` ' (ark or GCoCu�n <br /> } ariDate Nodfed• One <br /> Tfine: <br /> D• RESPONSIBLE PERSONBUS c *F _ <br /> . Name of Business: ~ <br /> Contact Person: <br /> Physical Address,. `CP Tele <br /> Ming Address: 1.ph° = ) <br /> E. DESCRIPTION I <br /> Type of Discharge: <br /> Volume: <br /> Chemicals: <br /> CiItiZIlIlStanCeS: <br /> SCG <br /> F. A1.1 iON�AItE1�1 awe— r'�C�tr A--P <br /> : " <br /> y - <br /> i <br /> SrrE DISPOSION <br /> A r <br /> i <br /> EH 22 013 (Rev.4/91) <br />