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0 0 <br /> 20. A written report to the appropriate office of the California Deparment of <br /> Health Services is required within 15 days after the incident when the <br /> release of a hazardous material posed a hazard or potential hazard to <br /> human health and safety, property, or to the environment. <br /> Contact your Regional or Departmental Environmental Coordinator for <br /> assistance in preparing this report. <br /> The report should include the following information: <br /> a. Name, address, and telephone number of facility manager. <br /> b. Name, address, and telephone number of facility. <br /> c. Date, time, and type of incident (e.g. , fire, explosion, spill , etc. ) . <br /> d. Name and quantity of waste(s) involved. <br /> e. The extent of injuries, if any. <br /> f. An assessment of actual or potential hazards to human health or the <br /> environment, where applicable. <br /> g. Estimated quantity and disposition of recovered wastes and cleanup <br /> material . <br /> 5-9 <br />