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UIN' OUN'TY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCE` LEVE PHS-EH LOG <br /> II <br /> C� d <br /> � ,ircle ane) <br /> B, SOURCE OF INFORMATION <br /> Phone: (3u-\) 52t�— <br /> Name: `��`- <br /> Company:G� ��-`t�.0 a o.S S� <br /> Address:\ o Phone: <br /> Designated Employee Name: <br /> Reporting Agency Name: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Olt , <br /> Location: oea (City County Circle one <br /> (Best Physical Description) <br /> Date of Discharge: Tame: <br /> Date Notified: l ti <br /> D. RESPONSIBLE PERSOWBUSINESS <br /> Name of Business-.,,) v��s i phone: <br /> Contact Person: <br /> Phvsical Address: <br /> N120ling Address: <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume-. <br /> Chemicals: <br /> CirCLIMstances: <br /> F. ACTION TAKEN x� � <br /> SITE DISPOSITION -to <br /> EH 22 013 (Rev.08/20198) <br />