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20. A written report to the appropriate office of the California Department of <br />Health Services is required within 15 days after the incident when the <br />release of a hazardous material posed a hazard or potential hazard to <br />human health and safety, property, or to the environment. <br />Contact your Regional or Departmental * Environmental Coordinator for <br />assistance in preparing this report. <br />The report should include the following information: <br />a. Name, address, and telephone number of facility manager. <br />11 <br />• <br />b. Name, address, and telephone number of facility. <br />C. Date, time, and type of incident (e.g., fire, explosion, spill, etc.). <br />d. Name and quantity of waste(s) involved. <br />e. The extent of injuries, if any. <br />f. An assessment of actual or potential hazards to human health or the <br />environment, where applicable. <br />g. Estimated quantity and disposition of recovered wastes and cleanup <br />material. <br />5-9 <br />