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® Page I of 6 <br />PCB/OIL SPILL or LEAK REPORT - (Re,,- I,M) <br />GENERAL IDENTIFICATION: A/R # _ D&C# Job Est# <br />Department 6, -;OL Division <br />Headquarters S tock4ow H+r-• N Ci Substation Stook+ ---i _ Stafttiovt 'A' Circuit <br />SPILL �l t INFORMATION: <br />City S5 o�c,�. 40AJ County � T4 �� 1 Specific Location of Spill (Address) <br />lC,�► <br />Ch4ree+ be�-wee�n (_e..4� St S_L • L<nGl E � 'DO,ILCIO . <br />Date of Spill 717 17 Time of Spill 1('66 h rs <br />Person reporting spill to PG&E (name) WA <br />PG&E Employee receiving initial spill notification (name) �Q nAZ-emecto <br />PG&E Supervisor in charge of cleanup (name) M;k,- R aw►Cy <br />Type of Equipment Involved: <br />Amount of Fluid Released (gallons): 0- z'5 <br />Telephone <br />Telephone (7-o J) 44Z - 15 00 <br />Telephone _ C20 4 ) 9.q 2 - ISO ( <br />ElCapacitor KVAR � Transformer KVA ❑ Other KVA (AMPS) <br />Cause: <br />❑ Unit Failure ❑ Third Party Accident ❑ Unit Damaged During Handling ❑ Lightning <br />. Unit leaking ❑ Other (describe) <br />Fluid Identification: ❑ Manufacture's Non -PCB Nameplate PG&E Analysis Tag w/supporting report ❑ Sample Analysis by a Certified Lab. <br />(attach copies of Laboratory Analysis Reports) <br />Spill Classification: (see page 2 for PCB weight calculations) <br />❑ High Concentration PCB's ( 500 ppm or greater) or Low Concentration PCB's involving one (1) pound or more of PCB by weight <br />JN Low Concentration PCB's (50- < 500 ppm) ❑ Calif. Regulated PCB's (5- < 50 ppm) ❑ Non -PCB Oil Spill (less than 5 ppm) <br />Spill Boundaries: /-' Clearly Visible * ❑ Can't be determined ** ❑ Involves water, grazing land, vegetable gardens, sewer or other sensitive conditions <br />* A Pre cleanup Statistical Sampling Plan is required to idents spill boundaries for 50 ppm or greater PCB spills. <br />"Immediate Agency Notification may be/is Required (seepage 3 of this form and PCB/Oil Cleanup Manual instructions). <br />Spill Category: <br />❑ Non restricted Access <br />General Description of Spill Area: <br />XRestricted Access <br />Outdoor Substation <br />❑ Private Property ❑ Public Property 9 PG&E Property El Industrial Area El Business District <br />❑ Residential Neighborhood -(Street Area) ❑ Residential Neighborhood -(Rear Lot Line) ❑ School/Playground or Park Area <br />❑ Medical Facility/Rest Home ❑ Waterways (river, drainage ditch, creek, canal, pond, pool, etc.) ❑ Farm/Ranch <br />❑ Shopping Center ❑ Major Freeway/Highway/Road ❑ Rural Highway/Road ❑ Residential Street/Sidewalk <br />❑ Other Areas (Describe) <br />Types of Surfaces/Media Involved: <br />❑ Asphalt <br />❑ Concrete <br />Dirt Gravel ❑ Decorative Rock ❑ Lawn <br />❑ Flower beds <br />❑ Ground Cover <br />❑ Shade Trees <br />❑ Shrubs ❑ Buildings/Structures <br />❑ Pole and Hardware <br />❑ Fence or Wall <br />❑ Vehicles <br />❑ People <br />❑ Domestic Animals ❑ Wildlife <br />❑ Grazing Land <br />❑ Agricultural Crops <br />❑ Water <br />El Fruit Trees <br />❑ Vegetable Gardens Other (Describe) <br />14Chi C case �9 <br />(' <br />71'"S fs --elf . <br />