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UNAUTHORIZED DISCHARGE LOG <br /> Date/Time <br /> Location <br /> Material or Waste <br /> Amount <br /> Injuries, If Any <br /> Cause <br /> Corrective Actions Taken <br /> Date�fime <br /> Method of Disposal <br /> Reportable Discharge <br /> No Yes <br /> If yes, see the Notification Procedures <br /> Responsible Official <br /> Title <br /> Signature <br /> A reportable discharge is defined as any spilling, leaking, pouring, escaping, etc., that is <br /> not permitted or authorized by a regulatory agency. <br /> The reporting is not required if there is reasonable belief that the discharge poses no <br /> significant threat or potential hazard to: <br /> ❖ Human health and safety <br /> • Property <br /> ❖ Environment <br /> leaks, or other releases of hazardous materials or waste. <br /> This form used tlog spills, <br /> contingency Plan <br /> 500 South Beckman Road 11.8 <br /> ArmorStruxx, LLC Lodi,CA 95240 <br /> March 2013 <br />