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SPILL REPORTING FORM <br /> VALLEY PACIFIC PETROLEUM SERVICES <br /> 1512 WEISS WAY <br /> ESCALON, CA 95320 <br /> Material released: <br /> Quantity of material released: <br /> Location of release: <br /> Date and time of release: <br /> Nature of release: <br /> Who was notified of release: <br /> Was the spill stopped and contained? O Yes O No <br /> Did the spill reach: Storm water System O Yes* O No <br /> Adjacent Properties O Yes* O No <br /> What response was taken to mitigate the spill? <br /> What measures have been implemented to prevent future spills/releases? <br /> *Please complete the Emergency Response Agency Notification Form. <br />