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PCB/OIL SPILL or LEAK REPOR <br />AGENCY NOTIFICATIONS (Telephone notifications should be made as soon as possible but must be made within 24 hours) (IF REQUIRED): <br />National Response Center Date AJIR Time Report # or Name By (name) <br />Phone(800)424-8802) <br />EPA Region IX Date N R Time Report # or Name By (name) <br />Phone (415) 744-1001 <br />Page 3 of 6 <br />(Rev. 12/94) <br />California OES Date '7-16-71 Time I -M Report # or Name i?- Z7 / 4 By (name) �• Goss Q/" j <br />Phone (800) 852-7550 or (916) 262-1621 <br />County EnvirQnmental Health Date 7-10-11 Time 15-54 Report # or Name Cava <br />ya -D'SQ By (name) <br />Phone C26 I ) 469- 34 Zo <br />RWQCB Date h�P%Time Report # or Name By (name) <br />Phone <br />OtherCDUtfi DES Date 7-10-97 Time 1552 Report#or Name Arj &IC By(name)F,- GsSGrd <br />Phone 20 <br />Other Date Time Report # or Name By (name) <br />Phone �p <br />Written Follow-up Report (within 30 days) sent to Cal: OES (attach copy) Date V $ 9 By (name) _ !t 6-vsS4rj <br />/. .o..� 7v. <br />Is a Pre cleanup Statistical Sampling Plan Required? No ❑ Yes (Complete below or attach a copy of the plan and of laboratory analysis results) <br />Are Special Cleanup Efforts Required by Spill Conditions or Regulatory Agencies? 1� No ❑ Yes (describe) <br />