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WSTD Incident Report <br />Report ID <br /> <br />Water Supply and Treatment (WSTD) Incident Report Page 3 of 6 <br />Revision Date: 10/18/18 <br />A. Responder’s Information <br />1. Name 2. Work Phone <br />Ian D. Macaulay 209-834-9100 <br />3. Supervisor's Name 4. Work Phone <br />Justin Sibbring 925-862-5717 <br />B. Incident Description <br />5. Name of Incident <br />2019-03-20 Tesla Treatment facility-UV 2040 2-2 lamp break <br />6. Facility Location 7. Incident Location <br /> Tesla Treatment Facility Tesla Treatment Facility <br />8. Date 9. Time 10. Any Injuries or Fatalities? <br /> 3/20/2019 1251 ☒ No ☐ Yes; if yes - describe the injury below. <br />11. Description of Injuries or Illness <br /> <br />12. Notifications to Regulatory Agencies <br />☐ California Unified Program Agency (i.e., County) Click or tap here to enter text. <br />☐ California Office of Emergency Services Click or tap here to enter text. <br />13. Notes from Notifications to Regulatory Agencies <br />