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�%4Uity t ..IVUIV I Y , <br /> NC"- rICATION OF HAZARDOUS V 'i_^CE DISCHARGE <br /> HEALTH & SAFETY COD. 180.7 <br /> N - <br /> f\ r <br /> A. EMERGENCY LEVE : I J II III ( ' <br /> (Circle One) \/ PIIS-EhLLO> `# <br /> B. SOURCE OF INFORMATION <br /> Original Source: ('j jam. fir , Telephone: (2ttttt <br /> „ � r <br /> )__ /6P - 3yrio <br /> Reporting Agency Name: Jrggr/i,, r,U , pub yip <br /> Agency Contact: Telephone: <br /> Address: /, 0 , BOX 2007 V" 1, 4» v rw r75 ZO J <br /> C• LOCATION AND DATE OF DISCHARGE <br /> Location: l s S c/ DoNic% S or <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: 6t ti kn <br /> Date Notified : 9/(/ y Time: �r�M <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business - rn I. 4) lvrc k <br /> Contact Person: jQL},�, Telephone: (��) �16� - 3:s �/ <br /> Physical Address: '3105 C' E7 r ,r <br /> E. DESCRIPTION <br /> Type Release: i ArZ <br /> Volume: <br /> Chemicals: Z�031Qfrn/P Iaa</ro� irh� r <br /> r• ACTION TAKEN <br /> aim<� �� G�Pftryvic✓� /r�iN .c.E.<{re<z' �J1 -,� !'t•�r'.� <br /> "p, <br /> IYY <br /> / :121Z!1Io rn��rrcrri- <br /> V / <br /> EI-I 22 013 (Rev. 02/90) <br />