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SAX .JOAQUIi`+ COUNTYy qw qw c ln i y <br /> NOTIFICATION OF HAZARDOUS WASTE DIS E <br /> HEALTH & SAFETY CODE 2-4180./ <br /> A. E.IERGENCY LEVEL II III PHS-crI LOG r <br /> ircle one) <br /> B. SOURCE OF CIFOR.bL-MON <br /> Name: Phone: Wh 571-O`i 0 U <br /> COmDany: e , Com. La bc;n ri er <br /> Address: ) 4-0-s A Sa 5 -e- M_e-v(c- +Z <br /> Designated Emoiove:Name: Phone: <br /> Renordng Agency"Name: <br /> Address: <br /> C. LOCATION-kNL D DATE OF DISCI-LARGE <br /> Locanon: 1 r-- P0(t ( 4'1-N Pr •'� <br /> (Best Physicai Descnorion) r County) Circle one <br /> Dare or Discaarge: U ipCn LW r1 <br /> Dare`rodned Tune: <br /> D. RESPONSIBLE PERSONBUSINESS <br /> Name or Business: l 10 r <br /> Tn c� <br /> Conract P_son r- r Phone: 7rrr S " <br /> Physical Address: 3-� 'Z P- , <br /> Vlailine Address: <br /> E. DESCRIPTION <br /> Twe of Discharge: ec- k <br /> Volume: l r L- ow"- <br /> Chemicals: D t e e <br /> C:rcumsmnces- z tzu e 5oT Sai- o f rtSu D a i vt e <br /> l,{ 1 <br /> F. ACTION TAKEN U S i Q vo o <br /> SITE DISPOSITION <br /> w-vU/\ Ura 12 <br /> B-r\ � <br /> EFi __ 0 L3 (Rev. 03/20/93) <br />