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APPENDIX I <br /> Discharge Notification Form <br /> Part A: Discharge Information <br /> General information when reporting a spill to outside authorities: <br /> Name: A.L.Powell Trucking <br /> Address: 23545 E Arthur Rd <br /> Escalon, CA 95320 <br /> Telephone: (209) 838-7470 <br /> Owner/Operator: A.L.Powell Trucking <br /> 23545 E Arthur Rd <br /> Escalon, CA 95320 <br /> Primary Contact: Garrett Bomer, Dispatcher <br /> Work: (209) 838-7470 <br /> Cell: (209) <br /> Type of oil: Discharge Date and Time: <br /> Quantity released: Discovery Date and Time: <br /> Quantity released to a water body: Discharge Duration: <br /> Location/Source: <br /> Actions taken to stop, remove, and mitigate impacts of the discharge: <br /> Affected media: <br /> G air G storm water sewer/POTW <br /> G water G dike/enclosure <br /> G soil G other: A.L.Powell Trucking <br /> Notification person: Telephone contact: <br /> Business: <br /> 24-hr: <br /> Nature of discharges, environmental/health effects, and damages: <br /> Injuries, fatalities or evacuation required? <br /> Part B: Notification Checklist <br /> Date and time Name of person receiving call <br /> Discharge in any amount <br /> Garrett Bomer & Response Coordinator <br /> (209) 838-7470 il <br /> Discharge in amount exceeding 10 gallons and not affecting a waterbody or groundwater <br /> 60 <br />