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Discharge Notification Form <br /> TEC EQUIPMENT INC. <br /> 2050 East Louise Avenue, Lathrop, California <br /> Part A: Discharge Information <br /> General information when reporting a spill to outside authorities <br /> Facility name, address and contact number: TEC Equipment Inc. <br /> 2050 East Louise Avenue <br /> Lathrop, California 95330 <br /> (209) 207-2010 (Office) <br /> Owner/Operator, address and contact number: TEC Equipment Inc. <br /> 750 NE Columbia Boulevard <br /> Portland, OR 97211 <br /> 800.525.6333 <br /> Emergency Coordinator, office address and Marcus Camargo, Assistant Service Manager <br /> contact number: 2050 East Louise Avenue <br /> Lathrop, California 95330 <br /> (209) 781-4579 (Office) <br /> (209) 207-2750 <br /> Alternate Facility Employee: Mike Hernandez, Service Manager <br /> (510) 921-6703 (24 Hour availability) <br /> Type of oil: Discharge Date and Time: <br /> Quantity released: Discovery Date and Time: <br /> Quantity released to a water body: IDischarge Duration: <br /> Location/Source: <br /> Actions taken to stop, remove, and mitigate impacts of the discharge: <br /> Affected media: <br /> ❑ air ❑ storm water sewer/POTW <br /> ❑ water ❑ dike/berm/oil-water separator <br /> ❑ soil ❑ other: <br /> Person Notified: Telephone contact: <br /> Business: <br /> Agency/Department: 24-hr: <br /> Nature of discharges, environmental/health effects and damages (if any): <br /> Injuries, fatalities or evacuation required? <br /> Date: Time: Name: <br />