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SAN .J0AQUD_ C0U-NT-Y • <br /> NOTIFICATION OF H.-kZ.ARDOt;S WASTE DISCHARGE <br /> py <br /> HE:kLTH & SAFETY CODE 2_5130.7 <br /> A. Ev[ERGENCY LEVEL lI III PHS-EH LOG T �� • �� <br /> (Circle one) <br /> B. SOURCE OF INFORMATION <br /> Fame: Phone: ( ) <br /> Company: <br /> Address: <br /> Designated Emplover dame: Phone: <br /> Repotting Agency Name: 751,j ,<L A�y, ,t�. / .J ��v Address: ScD, G iJ�,k.� ��;`� ./t7 <br /> T r <br /> C. LOCATION ?IND DATE OF DISCK-kRGE / <br /> Location: Z? <br /> (Best Physical Descrip on) County_ ) Circle out <br /> Dace or Discaar;e: <br /> Date waned:_ — �,— Tune: <br /> D. RESPONSIBLE PERSON/BUKNESS 9 <br /> Name or 3usiness: Sc �G ACX <br /> Contac: Person: Phone: <br /> TvTvP <br /> Physical address: Z 3 � cj �..(c� <br /> ` <br /> �75�-fid <br /> . ailinu Address: <br /> E. DESCRIP I ON <br /> Type of'Discharge: J111N�- <br /> Volume: <br /> Chemicals: el <br /> Circums-canc:s: <br /> F. ACTION TAKEN <br /> SITE DISPOSITION �-C� ^ `� <br /> EH 22013 (Rtv. 1). <br />