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PGas and l Company PCB /Oil Spill or or Leak Report 1 Cleanup Performed By PG&E Crews? �K Yes ❑ No (Name of Contractor) Number of people involved in cleanup: PG&E Employees —5 Contractor Employees Protective Clothing Used During Cleanup: ❑ Coveralls X Plastic Booties ❑ Other (Describe) 613685 (8/94) Distribution Page 5 of 6 Other (Describe) .,*,vex Gloves ❑ Respirators Post cleanup Sampling Required? Yes (Attach a copy of the sampling Sketcb/Grid and of laboratory analysis results) ❑ No (Explain Post cleanup Laboratory Analysis Results: Number of soil samples analyzed Highest Level Reported_ppm(TTLC) Number of wipe samples analyzed Highest Level Reported ug/100 sq.cm. Number of liquid samples analyzed Highest Level Reportedpm (Copies of all Laboratory Analysis Reports and sampling sketches should be attached to this form) Were adverse conditions encountered that delayed the start of cleanup for a High Concentration PCB's (500 ppm or greater) or Low Concentration PCB's involving one (1) pound or more of PCB spill for more than 24 hours or the completion of cleanup for a Low Concentration PCB's (50-500 ppm) spill within 48 hours? ❑ No ❑ Yes (Describe the delay) Date of Delay Time of Delay Length of Delay Certification: (Certification is required for all Federal low and high concentration PCB spills) CLEANUP CERTIFICATION Under civil and criminal penalties of law for the making or submission of false or fraudulent statements or representations (18 U.S.C. 1001 and 15 U.S.C. 2615) I certify that the information contained in or accompanying this document is true, accurate and complete. As to the identified section(s) of this document for which I cannot personally verify truth and accuracy, I certify as the company official having supervisory responsibility for the persons who, acting under my direct instructions, made the verification that this information is true, accurate and complete. Cleanup has been completed in accordance with the requirements of 40 CFR 761 and/or CAC Title 19 as described above on (enter date) at (enter time) Certified by: (type or print certifying supervisor's name) (signature)