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06-29-2007 03:15 From-DES HQ ANTO W/C 916-845-8910• T-018 V001/001 -F=290 <br /> Oils <br /> .,, GOVERNOR'S OFFICE OF EMERGENCY SERVICES <br /> Hazardous Materials Spill Report /V(I <br /> DATE: 06/29/200 RECEIVED BY: CONTROL#. <br /> TIME: 0237 OES- Courtland Ellis OES- 07.3909 <br /> 10SPR - INRC. <br /> <br /> <br /> <br /> I.-b. PERSON REP -TING SPILL(If different from above): <br /> 1. NAME: 2. AGENCY: 3. PHONE#: 4. Ext: 5.PAG/CELL: <br /> 2. SURSTANCE'TYPE: <br /> 2.a.SUBSTANCE: b.QTY,--c Amount Merasurr. c. I'YPT: d.OTHER; <br /> 1.Sulfuric Acid = 100 Ga[(s) CHEMICA1. <br /> 2- a <br /> 3. = <br /> e.'DC,SCRZPTION: Equipment failure caused this spill <br /> r-CONTAINED: g.WATER INVOLVED: h.WATERWAY; i.DRTNKOG WATER IMPACTED <br /> Yes No No <br /> 3. a.INCIDENT LOCATION: 16777 Howland Rd <br /> b.CITY: c.COUNTY: d.ZIP: <br /> Lathrop San Joaquin County 95330 O19A <br /> 4,INCIDENT DESCRIPTION: <br /> a. DATE: 06/29/2007 b. TIME (nq/atary):0210 (-, SITE: Industrial plant <br /> d. INJURIES# e.FATALS#: E EVACS 0; g.CLEANUP BY: <br /> 0 0 0 Reporting Party <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> 6. NOTIFICATION INFORMATION: <br /> ja.ON SCENE: b.OTHER ON SCENE: c.OTHER NOTIFIED: <br /> d.,\DMIN.AGENCY: San Joaquin COuilry E�nwrgency Smrices e. SEC.AGENCY: <br /> f NOTIFICATION LIST':'DOG Unit: RWOCR Unix: 58 <br /> I"An�cur� =fl uspws~ I J oH:u.o. I r FoOo a AG I_ E 0aH4 �.USCG <br /> I•'1 arc-osrR I ;Ala RS.aURCCS OD'..I nnn l..!►.ANW$ : ! <br />