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Spills/Illicit Discharge — Initial Contact Form <br />(Please print) <br />Date / Time of Incident Report • • 20? <br />Name of Reporting Party fritoputeL c.c.:4:2c-Atfr <br />Phone Number/ Email Address tanc5)54",-210p, rrlracileki)Citg of ft ron 0(43 <br />Address of Reporting Party <br />Zet . WILKA_As <br />Is anyone hurt? (describe) 1,10 <br />Description of spill / discharge (Type & amount, color, odor, solid, liquid, semisolid, liquid, <br />floatables, noticeable conditions): <br />PAI 3.t•D <br />Location of spill / discharge (Address, Landmarks, Closest Intersection): <br />nx 1 c..44 r7v1.61 U ivtabr.OL0V-il i2A2 Z7InfT \ver-4 <br />cic)0ikt-i ME • <br />Municipality cir( of gl BO LI County W4441044,4 us 1,1 <br />Description of discharge source (who is doing it, color of vehicle, license plate of vehicle, other <br />descriptors),i <br />-4111"tf°2 Olii-vr-- 2,200) oRkscia avs- S.tr-sasaLi c.01- c)0Zo <br />4.11-11"ta \./ MA LI e.E.14•Sft ik Sic 145 1.42. <br />Other notes: <br />What actions, if any, has the reporting party taken? <br />__Acrt-te EiaqPtlesiarm— %Mob CA•uzzzita 10 PRefoget <br />cLeAsta up of Iticilkt Q_SAL.S. fM <br />Name of City Staff person completing this form: Mt<AVI-E---t_ c., 1t7-4th <br />When 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 <br /> <br />Date Time <br /> <br />Call the Engineering Department: (209) 559-2108 <br />Name of person notified Date Time