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I� <br /> 1. Facility Owner and Opel ator <br /> I <br /> Ij <br /> Name Title el on Addrtss <br /> I <br /> z Facility contact <br /> Name Titleele h e I <br /> I I <br /> 3, Facility Description and address <br /> a Facility Operations <br /> b. Facility Storage <br /> istance to Navigable 4ti iters <br /> c. Dramuge PatbwUy and D <br /> I <br /> 13 <br /> 4 Spill History <br /> S Potential Spill Predictions,°ValUmes,RAtes and Control <br /> 6 Z reveutiou Measures Provided <br /> a. Drainage Control,Diversionary Structures and Coutalatment <br /> 'I <br /> b. Inspectivus(Record Keeping <br /> C Site Security <br /> d, Personnel Trainiag abd Spill Preveutivn Procedures I <br /> e. Spill Control EquipMent <br /> I� <br /> 7. Emergency Contacts <br /> !I <br /> 1 ac:ilty <br /> Nlanaztz Telephone N2. Pae-er yo, f <br /> I <br /> 2. Regulatory 6911W <br /> E <br /> Local Fire Departmout or Dxstrtct <br /> County Environmental Health <br /> Culifarnla Regional Water Quality Control Board <br /> Ca lorum Oflice of Emergency Services <br /> (if-pill rcach*S L SUrf3CC W vter) <br /> E� <br /> it <br /> 3 5 jjl Clea olntra <br /> Ii <br /> I, <br /> i <br /> 1V <br />