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12-OA-2005 I2:32 From-OES HO SACRAIENTO N/C <br /> 916-645-1910 T-064 P.OMUaM r-401 <br /> -.GOVERNOR'S OFFICE OF EMERGENCY SERVICES <br /> ?ECEIVEL-7 Hazardous Materials Spill Report <br /> RECEIVED BY: CO=- <br /> 6AN <br /> PATE: 12/08/2005 JOAQUIN OO[ OES_ Randy Basnw OETIME: 1907 OFFICE OF EMERGENCE OSPR- NR <br /> /.a. PERSON NOTIFYING VBRNOR'S OES: S.PAGICELL: <br /> I. NAME: <br /> 2. AGENCY: 3. PHONEM 4.Est: <br /> Art Bentley San Joaquin County OES 209.468-3969 <br /> 1.b. PERSON REPORTING SPILL(If different frown 3 ROPE#: 4.Ext: 5.PAG/CELL: <br /> 1. NAME: 2. AGENCY: <br /> 2. SUBSTANCE TYPE: M�Swe C.TYPE: d.OTHER: <br /> 2.a.SUBSTANCE: b.QTY:>=' A+so�m PETROLEUM <br /> _ 6 Galls) <br /> 1.waste Oil - <br /> 2. - <br /> 3. <br /> e.DESCRIPTION: Contained in one 6alloq milk lugs,found abandoned at a location <br /> f.CONTAINED: g•WATER INVOLVED: h.WATERWAY: 1.DRINKING WATER IMPACTED <br /> Yes No <br /> 3. a.INCIDENT LOCATION: petTon Road and Union Road near Manteca d ZIP: <br /> c•COUNTY: <br /> b.CITY: <br /> Unincorporated county area Sen Joaquin County <br /> 4.INCIDENT DESCRIPTION: <br /> a.DATE: 12/08/2005 b. TIME (Mdnary).'1638 c,SITE: Road g CLEANUP BY: <br /> d INJURIES# e.FATALS#: f.EVACS#: Reporting Party <br /> 0 0 0 <br /> Same as#1"PERSON NOTIFYING OES' <br /> 5. <br /> SUSPECTEDRESPONSIBLE <br /> :ARTY• c.PHONE#: d.EXT.: <br /> a.NAME: <br /> Unknown f.CITY: g.STATE: h. ZIP: <br /> e.MAIL ADDRESS: CA <br /> 6. NOTIFICATION INFORMATION: b.OTHER ON SCENE: c.OTHER NOTIFIED: <br /> la.ON SCENE: <br /> Co OES <br /> d.ADMIN.AGENCY: San Joaquin County EmeMtary SEn' SEC.AGENCY: <br /> aq <br /> nwQCB Ual[: 58 <br /> f.NOTIFICATION LIST: DOG URIC: <br /> __ - —�_. ... ❑usca -._ <br /> DNS.DQ ❑^FDDDiAG <br /> II�AA/NM 4J_ USF+'S 13ANDS 1—_J pN s&nsc ❑VSIXN <br /> y�I OPG-0SPR IJ A0.0.1�OUeCU Do �VOG ❑O�aAIMATUNIT IJ rUC LJ TER <br /> UTSC L cwLTMNS I I ea?"KiSFM <br /> n MS KAN3 UNR � ! <br /> I7/:1RW ae lJcoF I..1eMs. — <br /> fICO ALCOM L.I FEMA DOES REG LtAiMMS <br />