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Appendix F <br />Hazardous Waste Contingency Plan <br />Discharge Notification Form <br />Part A.• Discharge Information <br />General information when reporting a release to outside authorities: <br />• Store Name, Address, and Telephone <br />• Owner/Operator (The Home Depot U.S.A., Inc.) <br />• Primary Contact (General Manager or Designee) <br />Material released: <br />Discharge <br />Date and Time: <br />Quantity released: <br />Discovery <br />Date and Time: <br />Quantity released to a water body: <br />Discharge <br />Duration: <br />Location/Source: <br />Actions taken to stop, remove, and mitigate impacts of the discharge: <br />Affected media: <br />o air <br />❑ sanitary <br />sewer <br />❑ water <br />❑ secondary <br />containment area <br />• soil <br />❑ other: <br />Notification person: <br />Telephone <br />contact: <br />Business: <br />24 -hr: <br />Nature of discharges, environmental/health effects, and damages: <br />Injuries, fatalities, or evacuation required? <br />Estimated quantity and disposition of recovered material that resulted <br />from the incident: <br />