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Emergency Response Action Plan Version :27.10.4 <br /> Fields displayed in RED and with an *are mandatory entries. Please fill out the form as completely as possible. <br /> Is this a DRILL Report? YES NO *E-Mail Address: <br /> REPORTING • <br /> Last Name: *Last Name: <br /> First Name: First Name: <br /> Phone 1: Type: Phone 1: Type: <br /> (Primary,Alternate,Cellular,On-Scene,Pager,Other) (Primary,Alternate,Cellular,On-Scene,Pager,Other) <br /> Company: Company: <br /> Address: Address: <br /> City: City: <br /> *State: *State: <br /> Zip: Zip: <br /> Are you calling on behalf of responsible party: YES NO <br /> Are you or your company responsible for Material released: YES NO <br /> DESCRIPTIONINCIDENT <br /> *Description of Incident: <br /> Note: Include estimate of quantity spilled and an estimate of the quantity entering the water. <br /> * Incident Date: *Time: *Occurred/Discovered/ <br /> Planned: <br /> Day Month Year Occurred/Discovered/Planned <br /> * Incident Cause: <br /> (Aircraft Diversion,Criminal Intent,Cyber Attack,Derailment, <br /> Type of Incident:CONTINUOUS RELEASE Disorderly Passenger,Dumping,Transport Accident,Earthquake, <br /> Equipment Failure,Explosion,Flood,Hijacking,Hurricane,Natural <br /> Phenomenon,Operator Error,Other,Over Pressuring,Security Breach, <br /> Suicide,Suspicious Activity,Terrorism,Tornado,Transport Accident, <br /> Trespasser,Unknown,Vessel Sinking) <br /> Shell Supply and Distribution ERAP-14 Stockton Terminal FRP <br /> ©2019 Witt O' Brien's Revision Date:October, 2019 <br />