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SAN COUNTY <br /> NOTIFICATION OF HAZQARDO S WASTE DISCHARGI L E COPY <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEQ,;c1le <br /> PHS-EH LOG# O 1 -one) <br /> B. SOURCE OF INFORMATION 1 <br /> 01 <br /> Name: Da vi PAC Ya7 y��,^,l Phone: <br /> Company: YA <br /> Address: ✓ Of q,6ao <br /> p� Phone: ZOO fob- <br /> Designated Employee Name: L Duo- r DI <br /> V 1 OY� <br /> Reporting Agency Name: SSC - S' ' <br /> Address: 30 E E bt)Q�b?.K� � <br /> C. LOCATION AND DATE OF DISCHARGE <br /> 33oa W�� I <br /> Location: -e <br /> Ci r County) Circle one <br /> (Best Physical Description) <br /> Date of Discharge: c� d <br /> Time: I ,% A/1 <br /> Date Notified: <br /> D. RESPONSIBLE PERSON/BUSINESS �+,, <br /> Name of Business: �I(J h � 0�p- � w <br /> Contact Person: � 1V�Ct r _ honey ) '-1I�G a iv r <br /> Physical Address: ) ✓ S C <br /> Mailing Address: . D• 9U <br /> E. DESCRIPTION <br /> Type of Discharge: �/� a rlZPGQ rP,L�a a-2 <br /> Volume: 3Aes <br /> Chemicals:Circumstan <br /> F. ACTION TAKEN <br /> Sag DISPOSITION <br /> EH 22 013 (Rev. 08/20/98) <br />