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Spills/Illicit Discharge — Initial Contact Form <br />(Please print) <br />ab Date / Time of Incident Report Cez.- 01 - Zi <br />„l <br />AWL <br />Name of Reporting Party casc ft.tfota <br />Phone Number / Email Address (204:3) ScV)-aiper ) niroie Citt3 of rit,,,,,. ov3 <br />Address of Reporting Party <br />Zeic) VILtAot PAftni ) ciL cb53up <br />Is anyone hurt? (describe) i-1(7 <br />Description of spill / discharge (Type & amount, color, odor, solid, liquid, semisolid, liquid, <br />floatables, noticeable conditions): <br /> , AociAL <br />Location of spill! discharge (Address, Landmarks, Closest Intersection): <br />SALITOb A b-PEtoy.i =_Tigli 5/i,i-IpTcrb <br />.Municipality ccrrs( fki_Fog___ County 41 I <br />Description Description of discharge source (who is doing it, color of vehicle, license plate of vehicle, other <br />descriptors): <br />IF crzLNtt. <br />t tAp. 25cesn W55 <br />Other notes: <br />What actions, if any, has the reporting party taken? <br />cLP-A-Li Li? <br />Name of City Staff person completing this form: rAtriLla-t_ c. <br />When you you have completed the call, you must make the following required notifications: <br />*** Only if there is a fire, explosion, life, health, environmental threat or a need to evacuate <br />Call 911 <br />Call 911 *** <br />Name of person notified Date Time <br />Call the Engineering Department: (209) 559-2108 <br />Name of person notified Date Time