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0 0 <br /> ACTIVITY LOG (ICS 214) <br /> 1. Incident Name: 2. Operational Period: Date From:11/19/2012 Date To:11/19/2012 <br /> Super Store Industries I Time From: Time To: <br /> 3. Name: 4. ICS Position: 5. Home Agency(and Unit): <br /> Jeffrey Wong <br /> 6. Resources Assigned: <br /> Name ICS Position Home Agency (and Unit) <br /> 7.Activity Log: <br /> Date/Time Notable Activities <br /> 11/19/2012 12:20p Approximately 2 gallons of anti-freeze released when hose on truck broke. No surface <br /> water or storm drain was impacted. Absorbent was used to pick up the release on asphalt. <br /> Absorbent has been collected and stored in a hazardous waste container to be disposed <br /> by contractor(Clean Harbor) in 30 days. Gave Kelley a copy of inspection report requiring <br /> submittal of disposal record. Generated Prop 65 <br /> tk WFOIZ. o e4 2 1 V,_0 <br /> v V_ i'2_ d r <br /> I 2� Zd ZP41ce ( vin <br /> w� 6 <br /> C a <br /> a C au/ <br /> b e44, <br /> r , <br /> , <br /> or 5•-o ea? PO v—k �. <br /> 7S AA40 <br /> IZ <br /> 8. Prepared by: Name: Jeffrey WonG Position/Title: Sr REHS Signature: <br /> ICS 214, Page 1 Date/Time: 2012 November 19 <br />