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Spill Prevention, Control and Countermeasure Plan <br /> For Northern California Youth Correctional Facility <br /> APPENDIX D <br /> NCYCC PETROLEUM SPILL INCIDENT REPORT <br /> Name of Reporting Personnel: <br /> Phone Number of Reporting Personnel: <br /> Name and Address of Facility: NCYCC 7650 S. Newcastle Rd. Stockton, CA 95215 <br /> Date of Incident: Time of Incident: AM PM <br /> Location of Spill: <br /> Weather Conditions at the time of spill Location: <br /> Source of Cause of Spill: <br /> Type of Material(s) Discharged: <br /> Estimated Quantity of Material(s) Discharged: <br /> Corrective Actions and/or Countermeasures to Contain Discharge: <br /> Name of Pathway Affected (Creek, Lake, Pond, Soil Air): <br /> Number and Type of Injuries (if any): <br /> Additional Information for Emergency Responders: <br /> D-1 <br />