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KZ <br /> w <br /> 0 <br /> co <br /> REPORTING REQUIRED , <br /> EMERGENCY ORGANIZATION PHONE REQUIREMENTS NOTIFICATIONco <br /> Injury (any): Hospital: 911 * 1 . Name and telephone <br /> Ambulance: 911 ` of reporter Immediately or X <br /> Poisoning: Poison Control Center (800) 876-4766within 24 hours. <br /> Occupational Accident 2, Name and address > <br /> or Exposure Occupational Safety 8 Health (CAL-OSHA) (9 16) 263,2800'` of facility o <br /> Noti cation : m <br /> Fire/: Fire : - ' 7 - r 911 " <br /> n' <br /> Explosion PolicelSheriff: 911 * 3. Time and type of m <br /> Hazardous Material +Fire: 911 * incident (fire, chemical Agencies may <br /> Spill/Release +Trinity County Department of Health Division 530623-1459 release, etc. ). request a follow-up <br /> Outside Facility: +DISC Trinity CUPA (866) 34&0028 report In writing . <br /> +Nafional Response Center ( U. S. Coast Guard) (800) 424-8802 4 . Name and quantity of <br /> * CA EMERGENCY MANAGEMENT AGENCY 800 8524650 <br /> In addition to above Department of Toxic Substances Control , TRINITY (866) 348-0028 chemical or material . <br /> CUPA <br /> Storm Drain/Creeks Sewer District: 5. The extent of injuries , if any. Consult each <br /> River/Bays: Coast Unified Air Quality Management District (707) 443-3093 agency for their <br /> Sanitary Sewer: Fire , 911 6. Possible hazards to human reporting <br /> Gaseous Release into Trinity County Department of Health Division 530 623- 1459 health or the environment, requirements <br /> Atmosphere: Central Valley Regional Water Quality Control Board , outside the facility. <br /> Underground Storage Colorado River Basin (530) 2244845 <br /> Tank Leak/Spill: o <br /> Spill Cleanup Company: , Check with contractor <br /> contractor): YS I(}'I� ' $ - 37�j - rn <br /> Water District Utility: Eikd IG 11�10i^fC� joq . As soon as possible N <br /> Electrical: 74 11 2 and or as � <br /> Gas: ? & 7t) _Sj 3 above situation require§ <br /> Chemical Emergency Chemtrec, Chlorrep, Pesticide SafetyTearn {8q0) 4249300 <br /> Info . _ <br /> (1 ) After business hours use 911 to contact the Trinity County Department of Health Services Division of Environmental Health Services. — <br /> Denotes 24-Hour Number. + Required notification if hazardous materials emergency extends outside the facility or requires an evacuation of puMcareas it <br /> " Required notification for any hazardous materials or hazardous waste spills. M� Z <br /> CTI <br /> Page 34 of 37 <br /> �i <br />