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PACIFIC®ELL w <br />NEVADA BELL. <br />Pacific Telesis ConVanies Hazardous Material 1 r1C'd R <br />6 <br />FR 0023 13 851 <br />. too 0 1 a -?i <br />1 @11t @port <br />Location Of Release Person Reporting Incident Source Of Discharge li.e., Container, Veh., Facility) <br />Street Name Source <br />City State Tel. No. ( ► <br />Hazardous Material Quantity Released Date And Time Of Discharge <br />Material Quantity Date Time <br />Ilf Applicable) <br />Truck No. NA Or UN Code Placard/Label _ <br />Response/Clean-Up Initiated Weather Conditions <br />Northern CAL (415) 823-7777 <br />Emergency Control Center (ECC) Southern CAL 818-578-4941 <br />Nevada 702-786-0090 <br />Agency IAs Applicable) Tel. No. Date <br />National Response Center INRC) 800-424-8802 <br />Office Of Emergency Services (OES) CAL 800-852-7550 <br />California Highway'Patrol ICHP) CAL Zenith 12000 <br />Department Of Conservation And National Resources (DCNR) NEV 702-885-4670 <br />Division Of Emergency Management IDEM) NEV 702-885-5300 <br />Local Agency (Water Quality Control, Fire Dept., etc.I <br />Supervisor's <br />Signature <br />Title <br />Area And/Or Water Body Endangered <br />Extent Of Injuries, If Any <br />Time ( Agency Contact Name <br />Tel. No. ( I Date <br />Part 2 — Emergency Control Centers Copy <br />