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SPILL REPORTING FORM <br /> CITY OF RIPON—FUELING STATION <br /> 240 Doak Boulevard <br /> Ripon, California 95366 <br /> Date and Time of Release: <br /> Date and Time of Discovery: <br /> Material released: <br /> Quantity of material released: <br /> Quantity of material released to a waterbody: <br /> Location of release: <br /> Source of release: <br /> What response was taken to mitigate the spill: <br /> Was spill stopped and contained? ()Yes ()No <br /> Did the spill reach: Air ()Yes*()No Storm water System ()Yes*()No <br /> Water ()Yes*()No POTW ()Yes*()No <br /> Soil ()Yes*()No Adjacent Properties ()Yes*()No <br /> Containment O Yes*()No Waterbody O Yes*()No <br /> What measures have been implemented to prevent future spills/releases: <br /> Has the Emergency Response Agency Notification Form been completed: O Yes O No <br />