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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 />❑ 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 />❑ Was Cal OES Contacted (for Category 1 and greater than 1,000 gallons) (Y or N) <br />❑ Cal OES Control Number <br />NAME OF ON -CALL SUPERVISOR <br />SIGNED: <br />(On -Call Supervisor) <br />DATE: <br />(MM/DD/YY) <br />REVISION 3.0 (10/13) 19 F-90 24 <br />