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SAN CUNTY <br /> NOTIFIC�ON OF JOHAZARDOUS WASTE DIS�IARGE J <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: I I III PHS-EH LOG <br /> ( ' cle One) <br /> U, <br /> B. SOURCE OF INFORMATION <br /> Name: Phone: �) <br /> Company: <br /> Address: <br /> Designated Employee Name: /e- phone: i�ir C33� <br /> Reporting Agency Name:f j. <br /> Address: UNS Ili . Sitm lan <br /> C. LOCATION AND DATE OF DISCHARG <br /> Location: c) —7/ybLi/CCt+ a� I /� r/� / Sf�Gre <br /> (Best Physical Description) (Ci or County) Circle One <br /> Date of Discharge: <br /> Date Notified: C/ Zr -19 Time: t ' -*v <br /> D. RESPONSIBLE PERSQN/BUSINESS <br /> Name of Business: V i llC2�C- CG'�5f /�/Ct r/n cti <br /> Contact Person: t-(1P, Telephone• L)- <br /> Physical Address: 6.f U �n h�c2c�v c� i yii j, ��-Y, 45ZG�i <br /> Mailing Address: o <br /> E. DESCRIPTION <br /> Type of Discharge: razK 7� <br /> Volume: / <br /> Chemicals: <br /> Circumstances: hl /ivu �afz ' e2. i <br /> F. ACTION TARN (/iI O L %�19� /'DiiJ1 fY,c �777J�?Qc7 /L� cu <br /> SITE DISPOSITION i/ lc)m6 <br /> f orf �x 2 <br /> vig <br /> U/ <br /> EH 22 013 (Rev.4/91) <br />