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0 r <br /> SAN JOA IN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISC' TARGE 100 <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: II III S-EH LOG # qb ` d 3D <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: f j'� ® D9lunQb Telephone: <br /> Reporting Agency Name: T600c �P_l,C .S!ruias - yir �� ,�•vrs� <br /> Agency Contact: 10ei n CL HSY?W Telephone: <br /> Address: 16 01 f��Li�°! fl 1K' ?�D l'�SC o2oDq �$f �5a0/ <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: _,La ao e <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: <br /> Date Notified: Time: <br /> D. RESPONSIBLE PERSON/BUSINFSS <br /> Name of Business Cali 6)rn%,n- �)Vrr Seruice- <br /> Contact Person: n'J G Cam e_ Telephone: a( 0q ) _46,4- &311 <br /> Physical Address: S& (j .y-yL <br /> E. DESCRIPTION <br /> Type Release: adj, o_i-;9eac r-C/e 6LSC- <br /> Volume: U_14�� <br /> Chemicals: ii jf <br /> F. ACTION TAKEN Soil -S4,rn 1e-,' I&ICe,-, l,7di c"t UW101, hQ� o cccc,.-,-ems <br /> FUl-her si4e GLSSe.SSS'mer,f a,i // be r•�q ',. , <br /> de�*ernn,iit - --Vie <br /> 00 r u i rem(. 6 y La. I ✓' ul� - <br /> -0,, n CQ <br /> EH 22 03 (Rev. 7/89) <br />