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Appendix E <br />The Home Depot DC #5641 <br />Hazardous Waste Contingency Plan <br />Discharge Notification Form <br />?art A: Discharge information <br />General information when reporting a release to outside authorities: <br />Name: <br />The Home Depot Distribution Center #5641 <br />Address: <br />1400 East Pescadero Avenue <br />Tracy, CA 95304 <br />Telephone: <br />(209) 835-5133 <br />Owner/Operator: <br />The Home Depot U.S.A., Inc. <br />Primary Contact: <br />General Manager <br />Material released: <br />Discharge Date and Time: <br />Quantity released: <br />Discovery Date and Time: <br />Quantity released to a <br />water body: <br />Discharge Duration: <br />Location/Source: <br />Actions taken to stop, <br />remove, and mitigate impacts of the discharge: <br />Affected media: <br />o air <br />o sanitary sewer <br />o water <br />o secondary containment area <br />o soil <br />o other: <br />Notification person: <br />Telephone contact: <br />Business: <br />24 -hr: <br />Nature of discharges, <br />environmental/health effects, and damages: <br />Injuries, fatalities or evacuation required? <br />Estimated quantity and disposition of recovered material that resulted from the incident: <br />Arcadis U.S., Inc. Page 1 of 2 30017244.01 <br />