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� SAN t <br /> UNTY <br /> NOTIFICATION OF HAZARDOUOAQUIN S WASTE DISCHARGE �O p <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: Ili III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Name: TPcdc� Phone: (2w ) c%d8 Name: .- o33 <br /> Company: <br /> Address: <br /> Designated Employee Name: Phone: <br /> Reporting Agency Name: <br /> Address: S4 gSZo/ <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: zby <br /> (Best Physical Dp c pti�) ( County) Circle One <br /> Date of Discharge: NN o� <br /> Date Notified: Z 9 Time: <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: trr —71D4 <br /> Contact Person: Telephone: (rro) 675— / 5 <br /> Physical Address: / bio GvicG ow ,��jgzr_ RZ AO 01 9oa Cb�lc�eo cQ vY6z� <br /> Mailing Address: — -� <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: yn�Kr ow <br /> Chemicals: <br /> Circumstances: o6SE.214}r7ac�S �c�e in �� : ess o�c i_ z <br /> F. ACTION TAKEN v�4� .�� e�p SZiB9 +F ALV cv <br /> SITE STATUS S,; 'ZQ -7-2:) —7-74E Ca r , Sr iE <br /> Gorc r � r <br /> EH 22 013 (Rev.4/91) <br />