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• SAN 30AQU COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> ETY CODE 7 51.80.7 <br /> D L =HEALTH & SAF <br /> GENCY LEVE I II III EH LOG ,, <br /> EMER <br /> ircle one) <br /> B. SOURCE OF INFORNLATION, <br /> Phone: (Z") <br /> Name: -rim <br /> 4 <br /> Company: Atv �o a5l t� n V irn r+W S2! <br /> Address: "W Pb• $l�t.�k �`' <br /> Phone: 2s <br /> Name: <br /> Reporting <br /> Designated Employee a �� <br /> Name: <br /> Reporting Agency ✓f'u'^ �"�cr j h' q ZiJ <br /> Address'. ?0q �• W <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: S <br /> y one <br /> (Best Physical Description) . <br /> Date of Discharge: <br /> Time: ' 1;a 1 <br /> Date Notified- <br /> D- RESPONSIBLE PERSONMUSINESS <br /> , - <br /> Name of Business: S 0 � <br /> Phone: 2P.17 <br /> Contact Person: <br /> Physical Address: ba W e.t <br /> Mailing Address: <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: ONAA <br /> Chemicals: <br /> Circumstances'. fN <br /> I <br /> F. ACTION TAKEN <br /> SITE DISPOSITION '• <br /> EH 22 013 (Rev. 09120198) <br /> - r <br />