Laserfiche WebLink
DRAFT Ver. 1-C-doc-4-5-10 <br />Page 27 Tier II Qualified Facility SPCC Plan <br />In the event of a discharge of oil to navigable waters or adjoining shorelines, the following information will be provided to the National <br />Response Center [also see the notification information provided in Section 7 of the Plan]: <br />Table G-28 Information provided to the National Response Center in the Event of a Discharge <br />Discharge/Discovery Date Time <br />Facility Name <br />Facility Location (Address/Lat- <br />Long/Section Township Range) <br />Name of reporting individual Telephone # <br />Type of material discharged Estimated total quantity <br />discharged <br />Gallons/Barrels <br />Source of the discharge Media affected Soil <br />Water (specify) <br />Other (specify) <br />Actions taken <br />Damage or injuries Evacuation needed?No Yes (specify)No Yes (specify) <br />National Response Center 800-424-8802 Time <br />Cleanup contractor (Specify) Time <br />Facility personnel (Specify) Time <br />State Agency (Specify) Time  <br />Organizations and individuals <br />contacted <br />Other (Specify) Time <br />Facility Name: <br />ATTACHMENT 4 –Discharge Notification Form <br />CALIFORNIA FREIGHT ACAMPO <br />CALIFORNIA FREIGHT ACAMPO