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From, -Cal EMA (State Warning Center) 9168458910 12/30/2010 09:25 #333 P.001/001 <br />California Emergency Management Age d <br />Hazardous Materials Spill Repo <br />DATE: 12/30/2010 RECEIVED BY: CONTROL#: <br />TIME: 0915 Cal EMA - Courtland Ellis Cal EMA- 10-7970 <br />OSPR- NRC - <br /> <br /> <br /> <br /> <br /> : <br />2. SUBSTANCE TYPE: <br />2. a. SUBSTANCE: b.QTY:>=< Amount Measure G TYPE: d. OTHER: <br />1. Diesel = 80-100 Gal(s) PETROLEUM <br />2. _ <br />3. - <br />e. DESCRI1''171ON: During fueling of a customers tank incorrect calculations caused on over flow <br />f. CONTAINED: g. WATER h. WATERWAY: i.DRE TKING WATER IMPACTED <br />INVOLVED: <br />Yes No No <br />j. KNOWN IMPACT None <br />3. a. INCIDENT LOCATION: 3932 Newton Rd <br />b. CITY: <br />c. COUNTY: <br />d. ZIP: <br />Stockton <br />San Joaquin County <br />4. INCIDENT DESCRIPTION: <br />RWQCB Unit: 5B <br />a. DATE: <br />b. TIME (Military): <br />c. SITE: <br />d. CAUSE <br />12:'28/2010 <br />2220 <br />MerchantBusiness <br />Human Error <br />e. INJURIES <br />f. FATAIJCI'Y <br />g. EVACUATION <br />h. CLEANUP BY: <br />❑ Co/WP <br />® RWQCB ❑ CDF <br />------------------ <br />Responsible Party <br /> <br /> <br /> <br /> <br /> <br /> : <br />Ia. ON SCENE: b. OTHER ON SCENE: c. OTHER NOTIFIED: <br />d. ADMIN. AGENCY: San Joaquin County Emergency e. SEC. AGENCY: <br />Services <br />f. ADDITIONAL COUNTY: <br />g. ADMIN. AGENCY: <br />h. NOTIFICATION LIST: <br />DOG Unit: <br />RWQCB Unit: 5B <br />® AA/CUPA ® USFWS <br />❑ CDPH-D.O. <br />❑ FEMA ❑ Cal EMAREG <br />❑ UM MS ❑ OTHER <br />® DFG-OSPR ❑ AIR RESOURCES BD <br />❑ DOG <br />❑ FOOD &AG ❑ OSHA <br />❑ USCG <br />® DTSC ❑ CALTRANS <br />❑ DPR <br />❑ LANDS ❑ PARKS & RFC <br />❑ Co/WP <br />® RWQCB ❑ CDF <br />❑ EB PARKS <br />❑ Cal EMA HAZMATMM ❑ PUC <br />❑ Co/Hlth <br />NUS EPA ❑ COASTAL COM <br />❑ EMSA <br />❑ Cal EMA PLANS UNrr ❑ MW <br />® COM -111th <br />CONTIDENTIAL. <br />REMARKS <br />«'�arnlnm..:enier�a x:s.:.a.goy; R9_RRCCa_F,PA.GOV, DTSC.ER`fma11.:.om <br />