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PCB Gas and l Electric Company 623635 don <br />8194) <br />PCB/Oil Spill or Leak Report DbUPage Ion°° <br />Page 10[6 <br />GENERAL IDENTIFICATION: A/R# D&C# ob Est# <br />Region S ; Division J� CTS Imo- 10 District <br />HeadquarterssOCK1U`/ Substation-Llfoe Circuit U <br />SPILL INFORMATION: �r <br />City County�7 9wl'N Specific Location of Spill (address) <br />Date of Spillo ' - `j Time of Spill <br />Person reporting spill to PG&E (name) //!O Telephone �! <br />PG&E Employee receiving initial spill notification (name) /el Telephone Y'!'� - X67 �— <br />PG&E Supervisor in charge of cleanup (name) Ga.f {'C/ TelephoneYa ' /' � ' <br />C/L�� <br />Fluid Identification: <br />❑ Manufacturer's Non -PCB Nameplate <br />`Sample Analysis by a Certified Lab <br />&E Analysis Tag w/supporting report <br />Pattacb copies of Laboratory Analysis Reports) <br />Spill Classification: (See page 2 for PCB weight calculations) <br />❑ High Concentration PCB's (SOOppm or greater) or Low Concentration PCB's invalving one 1) pound or more of PCB by weight. <br />❑ Low Concentration PCB's (50-499ppm) ❑ California Regulated PCB's (5-49ppm) n -PCB Oil Spill (less than 5ppm) <br />Spill Boundaries: <br />❑ Clearly Visible 'Can't be determined "❑ Involves water, grazing land, vegetable gardens, sewer <br />or other sensitive conditions. <br />'A Pre cleanup Statistical Sampling Plan is required to identify spill boundaries for 50 ppm or greater PCB spills. <br />"Agency,Notification is Required (see page 3 of this form and CES Standard C-T&CS-50320 instructions). <br />General Description of Spill Area: <br />Private Property El Major Freeway/Highway/Road E]School/Playground or Park Area <br />Farm/Ranch El Residential Neighborhood (Rear Lot Line) E] Business District <br />❑ Shopping Center ❑ Residential Neighborhood (Street Area) ❑ Industrial Area <br />❑ Medical Facility/Rest Home ❑ Rural Highway/Road ❑ Residential Street/Sidewalk <br />❑ Public Property ❑ PG&E Property <br />❑ Waterways (river, drainage ditch, creek, canal, pond, pool, etc.) <br />❑ Other Areas (Describe) <br />Types of Surfaces/Media Involved: <br />❑ Asphalt <br />❑ Concrete <br />❑ Domestic Animals <br />❑ Shade Trees <br />❑ Shrubs <br />❑ Buildings/Structures <br />❑ People <br />❑ Wildlife <br />❑ Agricultural Crops <br />❑ Fruit Trees <br />'Wirt <br />❑ Grazing Land <br />❑ Other (Describe) <br />/,Coo, <br />❑ Decorative Rock <br />❑ Pole and Hardware <br />❑ Vegetable Gardens <br />❑ Gravel <br />❑ Flower Beds ❑ Lawn <br />❑ Fence or Wall ❑ Vehicles <br />❑ Water ❑ Ground Cover <br />