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PACIFIC BELL,,. <br /> NEVADA BELLY. FR 0023 13 851 <br /> (0010192%) <br /> Pectic Te1osia companies Hazardous Material Incident Report <br /> Date Location Of Release Person Reporting Incident Source Of Discharge li.e., Container, Veh., Facility) <br /> Street Name Source <br /> City State Tel. No. ( 1 <br /> Hazardous Material Quantity Released Date And Time Of Discharge Area And/Or Water Body Endangered <br /> Material Quantity Date Time <br /> Of Applicable) <br /> Truck No. NA Or UN Code Placard/Label <br /> Response/Clean-Up Initiated Weather Conditions Extent Of Injuries, If Any <br /> Northern CAL (415) 823-7777 <br /> Emergency Control Center (ECC) Southern CAL 818-578-4941 <br /> Nevada 702_ <br /> Agency Me Applicable) Tel. No. Date Time Agency Contact Name <br /> National Response Center (NRC) 800-424-8802 <br /> Office Of Emergency Services (OES) CAL 800-852-7550 <br /> California Highway.Patrol (CHP) CAL Zenith 12000 <br /> Department Of Conservation And National Resources IDCNR) NEV 702-885-4670 <br /> Division Of Emergency Management IDEM) NEV 702-885-5300 <br /> Local Agency (Water Quality Control, Fire Dept., etc.) <br /> Supervisor's <br /> Signature Title Tel. No. ( ► Date <br /> Pail 2— Emergency control Center''Copy <br />