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02-14-2008 18:57 From-OES HQ SACRAMENTO W/C 916-845-8910 T-98$ P.001/001 F-100 <br /> !� f GOVERNOR'S ACE OF EMERGENCY <br /> NN! SERVICES <br /> Hazardous Materials Spill Report <br /> DATE: 02/14/2008 RECEIVED BY: CONTROL#: <br /> TIME: 1843 OES- Darren Mitchell CES- 08-1348 O- .nEoD <br /> oSPR- NRC- <br /> <br /> <br /> I.b. PERSON REPORTING SPILL(If different from above): <br /> 1. NAME: 2. AGENCY: 3. PHONE#: 4.Ext; S.FAG/CELL- <br /> 2. SUBSTANCE TYPE; <br /> 2.a.SUBSTANCE: b.QTYI>=< Amount Measure c.TYPE: d.OTHER: <br /> 1_NH3 = unknown Lbs. VAPOR <br /> 2. <br /> 3. <br /> e.DESCRIPTION: Mechanical failure led to a release of less than 100 lbs of NH3. Product knocked down with <br /> water which then Flowed into a sel€containment area. <br /> f.CONTAINED; g.WATER INVOLVED: IN.WATERWAY: i.DRINEJNG WATER IMPACTED <br /> Yes No <br /> 3. a.INCIDENT LOCATION: 16777 Howland Road <br /> b.CITY; C.COUNTY: _ d.ZIP: <br /> Lathrop San Joaquin County <br /> 4.INCIDENT DESCRIPTION: <br /> a.DATE:02/14/2008 b. T11WE (MIRmy):1750 c.SITE: industrial Plant <br /> d. INJURIES# e.FATAL$#: f.EVACS#; g,CLEANUP BY: <br /> 0 0 0 Reporting Party <br /> <br /> <br /> <br /> <br /> <br /> <br /> 6. NOTI1+'1CATION INFORMATION: <br /> Ia.ON SCENE: b.OTHER ON SCENE; c.OTFIER NOTIFIED: <br /> County OES <br /> d.ADMIN.AGENCY: sun Joaquin County rz,=Lency Services e.SEC.AGENCY: <br /> E NOTIFICATION LIST; DOC tlnit: RWQCB Unit; 41D <br /> l^�—CU4'A r�p��usPWS ❑a,, D 0. LJ FQOP d AG LI 0SI1n U usca <br /> ^�DFG-08Pft L'J A>7t RESOORCFS Hp❑t>t7G ❑LANDS ❑PARKS R6C ❑US= <br /> OTSC ❑CALTRANS ❑fM PARKS ❑� -}� OW HAZWTUNIT ❑PUC ❑OTHER <br /> V a RWQCB ❑CDP 11 BMSA LJ on PLANS UNIT �❑7 mw <br /> L"'US om ❑COASTAt.CGM 0 miA ❑OES"r, L J usmms <br />