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0 SAN <br /> JUIN COUNTY is <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE FILE C <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVELocle <br /> II III PHS-EH LOG # 00 One) <br /> B. SOURCE OF-INFORMATION " <br /> Name: S� 0 G Phon 2 q <br /> Company: r <br /> Address• - .4 `- <br /> 4 <br /> Designated Employee Name: C1 ' _ Phone: (_) <br /> Reporting Agency Name: -e-- <br /> Address: <br /> C. LOCATION AND DATE F DISC GE / <br /> Location:-30-7a '�- <br /> (Best Physical scri tion (City r County) Circle One <br /> Date of Discharge: A • �d� <br /> Date Notified: L2000 Time:—'10~ <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business•. �Contact Person: 1 Telephone: <br /> Physical Address: <br /> Mailing Address: `'°GL YI.Q Cir O a-l!2-00e - <br /> E. DESCRIPTION l _ <br /> Type of Discharge: Q. ,� S S <br /> Volume: 1UvV,Kwj,%1 <br /> Chemicals: f <br /> 1 ; <br /> Circumstances: <br /> CUL nc)�— ` <br /> F. ACTION TAKEN <br /> r' OLVL1 )A all 0 - <br /> SITE DISPOSITION F f b <br /> EH 22 013 (Rev.4/91) <br />