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NOv J OAQ UIN COUNTY <br /> 4TION OF HA'LARD O U S WASP DIS <br /> HE--ALTI-I & SAFE-"TY CO D L 25-130.7 <br /> J U L 16 Tor <br /> A. EMERGENCY LEVEDIIII PHS-EH LOG ENVI 1 NJT <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: > u <br /> Telephoner <br /> Reporting Agency Name: ^ 1N. u4jfc. P_Cr �, SPrt//PSS <br /> Agency Contact: � �-- � U <br /> Telephone: QTII)14t�o— <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: /- ,��� <br /> (Best Physical 1//escrip�ion) (City or County) <br /> Date of Discharge: <br /> Date Notified: <br /> =—?'7 IqD Time: 2 . S-7) �/l,4' <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business _QSS <br /> Contact Person: � 'PS <br /> Telephone: <br /> Physical Address: <br /> E• DESCREMON �/ N <br /> 7pe Release: <br /> Volume: <br /> Chermcals: l� �l�►' <br /> r• ACTION TAKEN <br /> 4 1.4 Oar <br /> c'c <br /> A) <br /> L � � li� s <br /> s <br /> EI-1 22 013 (Rev. 02/90) <br />