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LODI ELECTRIC UTILITY <br /> Oil Spill Cleanup Record & Certification <br /> 1. Date and Time of Spill (Estimate if unknown): <br /> 2. Date & Time Cleanup Started: <br /> 3. Date & Time Cleanup Completed: <br /> a. If cleanup was delayed due to emergency or adverse weather, state nature and duration of <br /> delay: <br /> BOR ILL If /7V OR ASSNO 9 ED Til B TE - NOT. GC T0 9. <br /> 4. Pre-cleanup Sampling Data to establish spill boundaries when boundaries are undetermined <br /> (attach diagram of sample locations: <br /> a. Methodology used to establish spill boundaries.: <br /> 5. Description of Solid surfaces cleaned (sidewalk, wall, automobile, pole, etc.) <br /> a. Description of Decontamination Method Used: <br /> ❑ Double wash/rinse Method, etc <br /> ❑ Other: <br /> 6. Depth of Soil Removal (10" minimum for oil containing PCBs) <br /> a. Amount of soil (including grass and other vegetation): cu ft.,-gallons, <br /> drums or other measurable quantity <br /> 7. Post cleanup verification sampling data (for spill involving >270 gallons of untested oil or any <br /> quantity of 500 ppm PCB oil, or as required by local agency): <br /> 8. REOJJIRED IF SPILLED OIL CONTAINED PCBS• <br /> Certification: The undersigned responsible party certifies that the cleanup requirements outlined <br /> in 40 CFR 761.125 have been met and the information stated above is true to the best of his/her <br /> knowledge. <br /> Cleanup Supervisor: <br /> 9. Additional infonnation (not required by EPA): <br /> a. Estimated costs of cleanup Dollars <br /> b. Equipment nameplate data: <br /> C. Transportation of cleanup materials to Warehouse date <br /> d. Number of disposal containers: <br /> Copies to: Construction Maintenance Supervisor <br /> and/Warehouse <br /> c:\use rs\mkoinzan\appdata\local\microsoft\windows\te mpor ary internet file s\co ntent.outlo ok\squajvpe\oil spill report and clean up record andcerti ficatio n.doc <br /> 8/12/2014 <br />