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❑ Pre cleanup sampling Sketch/Grid ❑ Post cleanup sampling Sketch/Grid ❑ Cal -EPA Written Follow-up Report <br />❑ Laboratory Analysis Reports for Fluid Identification/Classification (Lab name <br />❑ Pre cleanup Laboratory Analysis Reports (Lab name <br />❑ Post cleanup Laboratory Analysis Reports (Lab name ) <br />❑ Photograph Identification Sheets ❑ Other Documents (Describe) <br />INVOLVED EQUIPMENT (SOURCE OF SPILL): <br />TECHNICAL DATA <br />CODE(S) $ <br />U -L- <br />OPERATING NUMBER <br />k J 'Ti r <br />C rh&3e <br />Page 6 of 6 <br />PCB/OIL SPILL or LEAK REPORT <br />EQUIPMENT TYPE <br />Awes Te.,S4rruf' <br />Unit Damaged by Car -Pole Accident or Other Third -Party Action <br />(Re,,. 12/94) <br />FINANCIAL COSTS OF CLEANUP: FS�MA:rtl <br />LI <br />Unit Failure Caused by Lightning <br />PF <br />PG&E Labor $ 1. 600 PG&E Equip. <br />$ 0 <br />PG&E Material $ �® <br />Subtotal $ 1, 6 00 <br />Contract Labor $ Contract Equip. <br />$ ""- <br />Contract Material $ '— <br />Subtotal $ — <br />Transportation $ 1 000 Disposal <br />$ f / O�0— <br />T <br />Other $ <br />Subtotal $ d <br />Grand Total of Cleanup Costs $ 0 <br />LIST OF ATTACHMENTS: <br />❑ Pre cleanup sampling Sketch/Grid ❑ Post cleanup sampling Sketch/Grid ❑ Cal -EPA Written Follow-up Report <br />❑ Laboratory Analysis Reports for Fluid Identification/Classification (Lab name <br />❑ Pre cleanup Laboratory Analysis Reports (Lab name <br />❑ Post cleanup Laboratory Analysis Reports (Lab name ) <br />❑ Photograph Identification Sheets ❑ Other Documents (Describe) <br />INVOLVED EQUIPMENT (SOURCE OF SPILL): <br />TECHNICAL DATA <br />CODE(S) $ <br />U -L- <br />OPERATING NUMBER <br />k J 'Ti r <br />C rh&3e <br />MANUFACTURER <br />SERIAL NUMBERS <br />EQUIPMENT TYPE <br />Awes Te.,S4rruf' <br />Unit Damaged by Car -Pole Accident or Other Third -Party Action <br />DU <br />Unit Damage (rust, tracking, etc.) <br />LI <br />Unit Failure Caused by Lightning <br />PF <br />Unit Damaged by Pole Fire <br />SF <br />Switch Failure (such as grounding switch on network transformers) <br />CH <br />Unit Damaged During Handling <br />UL <br />Unit Leaking or Sweating (Bushing), Gaskets Leaking or Sweating, but Fluid not Reaching Ground <br />Determine the Type of Spill from the Following: <br />Code <br />Type of Spill <br />OF <br />Unit Failure (other than by lightning) <br />CP <br />Unit Damaged by Car -Pole Accident or Other Third -Party Action <br />DU <br />Unit Damage (rust, tracking, etc.) <br />LI <br />Unit Failure Caused by Lightning <br />PF <br />Unit Damaged by Pole Fire <br />SF <br />Switch Failure (such as grounding switch on network transformers) <br />CH <br />Unit Damaged During Handling <br />UL <br />Unit Leaking or Sweating (Bushing), Gaskets Leaking or Sweating, but Fluid not Reaching Ground <br />PLEASE NOTE: THIS RECORD MUST BE MAINTAINED FOR AT LEAST 5 YEARS <br />f <br />Report Prepared by: ' `�o JCr+ 6CS44-J Phone(91(.' 91.3 —71I <br />