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Page 2 Of 6 PCB/OIL SPILL or LEAK REPOR 0 (Rev. 12/94) Weather Conditions: X Clear ❑ Windy ❑ Fog ❑ Cloudy ❑ Drizzle ❑ Rain, Moderate ❑ Rain, Heavy ❑ Lightning ❑ Snow ❑ Other IMMEDIATE ACTIONS TAKEN TO MINIMIZE HUMAN EXPOSURE, ENVIRONMENTAL IMPACTS AND PROPERTY DAMAGE: ❑ None Required Barricades 1 Absorbents ❑ Dirt berms or dikes ❑ Cover Stone or Sewer Drains ❑ Other (describe): PROPERTY OWNER NOTIFICATION: j44 ApekeAle- Property Owner's Name Telephone Address Property Owner Notified ? ❑ Yes By (name) Date Time ❑ No (explain) PCB Weight (RQ) calculations (Calculations required for all spills involving 50 ppm or greater PCB and for transportation spills involving 20 ppm or greater) Quantity of fluid released (Required for All Spills) 0.2-5 gallons PCB Concentration -61 ppm Calculation: Quantity of fluid released 0• z 5 gallons x S4 ppm = 0.0001 lbs. PCB or ❑ Calculations not required 135,000 Reporting Assessment - Federal EPA - (Spills of fluids containing 50 ppm or greater PCB Concentrations): ❑ Involves a spill of one (1) pound or more of PCB by weight ❑ Involves vegetable gardens ❑ Involves Surface Water or Drinking Water ❑ Involves Sewers or Sewage Treatment Systems ❑ Involves grazing land ❑ Involves special cleanup (i.e. fire, humans, animals, etc.) Any or all of the above conditions must be reported to the National Response Center (NRC), EPA, Region IX, and California OES. If water in involved, the Regional Water Quality Control Board must also be notified. Other agencies may also need to be notified as circumstances dictate: i.e. County Health Agencies, Fire Depts.,Cal-EPA, Police, Sheri CHP, etc. Reporting Assessment - Federal DOT -(Transportation Spills of fluids containing 20 ppm or greater PCB Concentrations): ❑ Involves a spill of one (1) pound or more of PCB by weight The above condition must be reported to the National Response Center (NRC), and California OES. The EPA, Region IX must be notified if the spill involves 50 ppm or greater PCB fluids. If water in involved, the Regional Water Quality Control Board must also be notified. Other agencies may also need to be notified as circumstances dictate: i.e. County Health Agencies, Fire Depts., Cal -EPA, Police, Sheri CNP, etc. Reporting Assessment - State of California -(Releases or Threatened Releases of Hazardous Materials): ❑ Involves a Release of 42 gallons or more of oil or petroleum products ❑ Involves sensitive areas such as schools and medical facilities ❑ Involves a spill of fluids containing 5 ppm or greater PCB off PG&E Property. ❑ Involves wildlife or domestic animals ❑ Involves a Release of a Hazardous Material to water or vegetable gardens ❑ Attracts public and/or media attention CpdN"j� Presents a significant threat to human health or the environment even if below RQ values 0i 1 i,, -r � 9rov,d W P O Z Any or all of the above conditions must be reported to California OES. The NRC and, the Regional Water Quality Control Board must be notified of releases that involve water. Other agencies may also need to be notified as circumstances dictate: i.e. County Health Agencies, Fire Depis.,Cal-EPA, Police, Sheri CHP, etc. fSPILL CONDITIONS DO NOT MEET ANY OF THE AGENCY NOTIFICATION REQUIREMENTS DESCRIBED ABOVE AND IS NOT EPORTABLE. RQ Calculations and Agency Reporting Determination completed by(name): f, • &Vf rAr4 Date: $ $ 9 RQ Calculations and Agency Reporting Determination reviewed by(name)s A zt''redo Date: 4 I %