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<br />THE FOLLOWING IS TO BE COMPLETED BY THE ON-CALL SUPERVISOR <br />SPILL CERTIFICATION <br />Did the sewer spill enter a storm drain pipe (Y or N) ______________________ <br />Location of storm drain pipe ________________________________________ <br />Was the sewer spill fully recovered and returned to the sanitary sewer system or disposed of <br />properly (Y or N) ____________________ <br />Did Sewer Spill enter a drainage channel and/or surface water (Y or N) ___________________ <br />(EX: Creek, River, or Ocean) <br />Name & location of drainage channel and/or surface water ____________________________ <br />Was Cal OES Contacted (for Category 1 and greater than 1,000 gallons) (Y or N) __________ <br />Cal OES Control Number __________________________________ <br />Was Santa Ana NPDES Contacted (for all Category 1 and sewer spills that enter the storm drain) <br />(Y or N) ________________ <br />NAME OF ON-CALL SUPERVISOR ______________________________________ <br />SIGNED: ________________________________ DATE: ____/____/____ <br /> (On-Call Supervisor) (MM/DD/YY) <br /> <br />REVISION 2.0 (04/23) 26 <br /> <br />