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-, II <br /> SAN 30AQUIN COUNTY 'f <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 II. <br /> A. EMERGENCY LEVEL: ii III PHS-EH LOG # <br /> (Circle One) 3i <br /> i <br /> I <br /> B. SOURCE OF INFORMATION <br /> Name: Prg-X[mt {Ze Port EJalucaitto7 Q� Soy l *6roJn Lxc4A Phone: CjLi <br /> Company: ArpNE„ea <br /> Address: 4 1 Q I E Powe, tart RSA . SQCrc nenb GA 4 co <br /> Designated Employee Name: I Phone: (� <br /> Reporting Agency Name: <br /> Address: II II' <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: 4(aq Vr- Aet(oa {,cnJ / San � <br /> 0=.q r,j l n <br /> (Best Physical Description) A. N l of-oZ l-3 2 (City o Coun Circle One <br /> Date of Discharge: V h nw)Y1 <br /> Date Notified: OJ 21 het I Time: S'`o d P <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: M0,rlo,4e- Proner'1'lf-S <br /> Contact Person: bona i'hp-ex �,kkrtoWC .II Telephone: (4t5 ) 457- I(o 7_9 <br /> Physical Address: <br /> Mailing Address: -P.0. Bo,� 160-111 ,- Rate l �I�CA ill,q 4q t5 <br /> E. DESCRIPTION <br /> Type of Discharge: UST UAC i. <br /> Volume: _ Lny rlc %1 3 <br /> Chemicals: 1-Q Ute 2Ck5011 MQ_ b-0 t M ! arucL rbcn5 <br /> Circumstances: r \lte-+u -', Clp-cen - 'Subvy,%44-4 a4 ±E4- <br /> F. ACTION TAKEN 5 r rnoJ ! I II . Tv\lo 50A bon <br /> ±p a\ shoct4-0 B-( and 5-71. E3-2- i �l�tiJ 1 _ ;? <br /> A� �'esuts thrltc�-+ed �ro�n�{ �a,. contarn(n4La� <br /> .I1: SIG <br /> i II II <br /> li II <br /> k II If <br /> SITE DISPOSITION Stk QLac.ed Ie�vsir1- r m <br /> td v a9 Gcr� rv�t c� w qk u ib ori <br /> rN�vx[ p-r [j24 VjUls -t s��totv :I h ILA- . �fL to"P' of <br /> St]L j a-y� gyoJ rtdwct-_4� cc�n.�'a+�l��.tto,•� a� �I <br /> II. Ij <br /> li <br /> i <br /> EH 22 013 (Rev.4/91) <br />