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PCB/OIL SPILL or LEAK REPORT16 Cleanup Performed By PG&E Crews? Yes ❑ No (Name of Contractor) Number of people involved in cleanup: PG&E Employees 3 Contractor Employees ^ Other (Describe) Page 5 Of 6 (Rev. 12/94) Protective Clothing Utilized During Cleanup: f� Tyvek Coveralls ;4 Plastic Booties � Solvex Gloves ❑ Respirators ❑ Other (Describe) Post cleanup Sampling Required? ❑ Yes (Complete below or attach a copy of the Sketch/Grid and of laboratory analysis results) 14 No (Explain why) ko ►c) Yo G' Ke G Oi f - SIP -.tied a.4L d S47nU Post cleanup Laboratory Analysis Results: Number. of soil samples analyzed Alo -'r- Highest level reported ppm Number of Wipe samples analyzed No'n,f. Highest level reported ug/100 sq.cm Number of liquid samples analyzed_Alc2w Highest level reported ppm (Copies of all Laboratory Analysis Reports should be attached to this jorno Were adverse conditions encountered that delayed the start of cleanup for a High Concentration PCB's ( 500 ppm or greater) or Low Concentration PCB's involving one (1) pound or more of PCB spill for more than 24 hours or the completion of cleanup for a Low Concentration PCB's (50-500 ppm) spill within 48 hours? XNo ❑ Yes (Describe adverse conditions that caused the delay) Date of Delay, Time of Delay Length of Delay, CLEANUP CERTIFICATION (Certification is required for all Federal low and high concentration PCB spills) Under civil and criminal penalties of law for the making or submission of false or fraudulent statements or representations (18 U.S.C. 1001 and 15 U.S.C. 2615) I certify that the information contained in or accompanying this document is true, accurate and complete. As to the identified section(s) of this document for which I cannot personally verify truth and accuracy, I certify as the company official having supervisory responsibility for the persons who, acting under my direct instructions, made the verification that this information is true, accurate and complete. d Cleanup has been completed in accordance with the requirements of 40 CFR 761 and/or CAC Tide 19 as described above on nt �� Y at �- I �� L'. W444-- � 9 (enter date) (enter time) Certified By: Y` ��"'" �O L e't -D. GO iS &'d (type or print certifying supervisor's name) (signature)