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"_COPY <br /> SAN TOAQUR� COUNTY FILE _ - <br /> NOTIFICATION OF IE[AZARDOUS WASTE SAFETY CODE 25180.7 SCHARGE <br /> HEALTH <br /> A. EMERGENCY LEVEL: I II III <br /> PHS-EH LOG u <br /> (Circle one) <br /> B. SOURCE OF INFORMATION <br /> Phone: (7qr7� • q)56D <br /> Name: � t(Qw� <br /> Company: Y S <br /> Address: <br /> Phone: 2Vq• $.3 <br /> Designated Employee Name: lea' �viY6�t �h <br /> Reporting A erscy Name: r 2DZ <br /> Address: W P or L <br /> C. LOCATION AND DATE OF DISCHARGE <br /> 145 N �_I#&YX4 ; c'S C, ) <br /> Location: D Gh v1� Ci or County) Circle one <br /> (Best Physical Description) <br /> Date of Discharge: Time: 2.*00p�n <br /> Date Notified: 5- <br /> D. RESPONSIBLE PERSONIBUSINESS <br /> Name of Business: YYl Y � •� <br /> �P <br /> Contact Person: Phone: L <br /> Phvsical Address: � Z v <br /> Mailing Address: b D <br /> E. DESCRIPTION <br /> Type of Discharge: 10 <br /> Volume: ►�- <br /> Chemicals: <br /> Circumstances: U1r�C�2X' <br /> tA <br /> F. ACTION TAKEN ds3 ytqy <br /> -ova IcnlmyraA <br /> SITE DISPOSITION <br /> EH 22 013 (Rev.08120193) <br />