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Cecchini Trucking Company Inc. <br />SPCC Plan <br />April 2020 <br />Page 55 of 63 <br />Information provided to the National Response Center in the Event of a <br />Discharge — Sample Only <br />Discharge/Discovery Date <br />Time <br />Facility Name <br />Facility Location (Address/Lat- <br />Long/Section Township Range) <br />Name of reporting individual <br />Telephone # <br />Type of material discharged <br />Estimated total <br />quantity discharged <br />FiIlons/Barrels <br />El <br />Source of the discharge <br />Media affected <br />Soil <br />❑ Water (specify) <br />Other (specify) <br />Actions taken <br />❑ ❑ ❑ ❑ <br />Damage or injuries <br />No Yes <br />(Necify) <br />L <br />❑J <br />Evacuation needed? <br />No Yes (specify) <br />Organizations and individuals <br />contacted <br />National Response Center 800-424-8802 Time <br />Cleanup contractor (Specify) Time <br />