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4D <br />4D <br />• <br />l:A <br />3 <br />4 <br />THIS FORM PROVIDES <br />GUIDANCE FOR INITIAL NOTIFICATION <br />SARA - TITLE III <br />SECTION 304 REPORTING FORM <br />Reporting Number (850) 413.9900 <br />General Information SARA LOG #- <br />A. Time/Date 1 <br />B. Reported by (Name/Company) <br />C. Contact Person (If different from 1-B above) <br />r) S nratinn <br />E. Telephone Number <br />Release Information <br />A, Substance(s) Involved <br />B. Release Medium: Air <br />Water (surface/ground) <br />Land <br />C. Event Terminated: Yes 1 No <br />Release Began , Ended _ , Duration <br />D. Quantity Released <br />F. EHS Release: Yes f No; CERCLA Release: Yes 1 No <br />Is this a Reportable Incident/Emergency under Section 3014? <br />Incident Description: <br />Indian River County Emergency Plan for Hazardous Materials Pagu Ji <br />