Do I need a notary for the Unauthorized Release / Contamination Site Report?

No. The report has signature and date fields but no notary block. The instructions do not identify a notarized or sworn attachment.

How do I submit the Unauthorized Release / Contamination Site Report?

The instructions say to keep a copy and forward the original to the local permitting agency. They also list copies for the regional board, local site mitigation program agency, local health officer, and owner or responsible party.

What information does the report request?

It requests reporter and responsible-party details, site location, substances and quantity lost, discovery and abatement information, source and cause, case type, current status, remedial actions, and comments.

Who completes this report?

The instructions describe completion by a business or property owner or their agent. The form also includes fields for the individual filing the report and the responsible party.

Milpitas, CA · Santa Clara County

No notary required

Unauthorized Release (Leak) / Contamination Site Report

This report documents an unauthorized leak or contamination incident for a responsible party, business, property owner, or agent to submit to the local permitting agency.

What this form is

Use this report to document an unauthorized release or contamination incident, including its location, responsible party, substances involved, discovery, cause, case status, and remedial actions. The instructions say the business or property owner, or their agent, should forward the original to the local permitting agency for distribution. The report also asks whether an emergency report was filed and provides space for comments.

Who needs it

A business or property owner, or their agent, completes and submits this report when documenting an unauthorized release or contamination incident.

How to submit it

If completed by a business or property owner or their agent, retain a copy and forward the original to the local permitting agency. The instructions list copies for other agencies and the owner or responsible party.

About notarization

This report is signed and dated without a notary; it does not identify any attachment or related step that must be notarized or sworn.

How to submit this form

1
Download The Report
Download the Unauthorized Release (Leak) / Contamination Site Report PDF.
2
Complete The Report
Fill in the reporter, responsible party, site, substance, discovery, source, case status, and remedial action information that applies.
3
Sign And Date
Sign and date the report in the spaces provided.
4
Keep A Copy
The instructions say the business or property owner, or their agent, should retain a copy.
5
Forward The Original
Forward the original to the local permitting agency for distribution, and provide the copies listed in the instructions.

Frequently asked questions

Do I need a notary for the Unauthorized Release / Contamination Site Report?: No. The report has signature and date fields but no notary block. The instructions do not identify a notarized or sworn attachment.
How do I submit the Unauthorized Release / Contamination Site Report?: The instructions say to keep a copy and forward the original to the local permitting agency. They also list copies for the regional board, local site mitigation program agency, local health officer, and owner or responsible party.
What information does the report request?: It requests reporter and responsible-party details, site location, substances and quantity lost, discovery and abatement information, source and cause, case type, current status, remedial actions, and comments.
Who completes this report?: The instructions describe completion by a business or property owner or their agent. The form also includes fields for the individual filing the report and the responsible party.

Need something notarized?

This Unauthorized Release (Leak) / Contamination Site Report doesn’t need a notary — but if you have another Milpitas form that does, a commissioned online notary can help.