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Spill Prevention, Control and Countermeasure Plan <br /> Tesla Treatment Facility <br /> Son eranuscr~ <br /> Water�," � 5=_r�-l WSTD Hazardous Material IlilcidentlRelease <br /> Reporting form <br /> Sei+nces 0tha Son Fr�lxlxo PuBIIC llillltles l:ommissron <br /> Instructions:Following the completion of the Release Assessment Form,and upon determination that <br /> this release is an incident that needs to be reported,complete the following and report incidentirelease to <br /> Cal OES at(800) 852-7550 or(916)845-8911 and to your local CUPA immediately. <br /> Incident/Facility Location: <br /> Date of Occurrence: Time: <br /> Hazardous Material (e.g. `25% Sodium Hydroxide'): <br /> Quantity(gal, Ib): <br /> Location (e.g. `Discharge pipe inside second containment): <br /> To Be Completed by Chief Stationary Engineer <br /> Root cause and result of release(s).Is there a potential for further release(s)? <br /> Were there any injuries as a result of the release? <br /> Who is the responsible party? <br /> How and when was the release discovered? <br /> Location of the release?Is this a recurring problem area,or concern for future releases? <br /> Provide how the clean-up(s)were handled,disposition of waste generated from clean-up activities,and <br /> provide any associated documentation. <br />