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from:CALIFORHIA STATE WARNING R 19168458910 04/2011 17:10 #455 P.0011001 <br /> s <br /> California Emergency Management Agenck�' <br /> Hazardous Materials Spill Report <br /> DATE: 04/25/2011 RECEIVED BY: CONTROL#: <br /> TIME: 1659 CalEMA. : RubenRodriguez CalEMA- 11-2596 <br /> OSPR- NRC- <br /> <br /> <br /> I.b. PERSON REPORTING SPILL(If different from above): <br /> 1. NAME: 2. AGENCY: 3. PHONE#: 4.Ext: 5.PAG/CELL: <br /> 2. SUBSTANCE TYPE: <br /> 2.a.SUBSTANCE: b.QTY: Am&-t Measure c.TYPE: d OTHER: e. VESSEL <br /> '=` >=300 Tons <br /> 1.98%Sulfuric Acid= 20 cai{s) CHEMICAL O Yes i No <br /> 2. - O Yes ♦ No <br /> 3. = O Yes • No <br /> e.DESC'RIVRON: A flange on the pipeline,or the pipeline itself,failed still under investigation. <br /> E CONTAINED: g.WATER h.WATERWAY: i.DRUgMG WATER IMPACTED <br /> INVOLVED: <br /> Yes No <br /> I.KNOWN IMPACT <br /> 3. a.INCIDENT LOCATION: 16777 Howland Road <br /> b.CITY: c.COUNTY: d.ZIP: <br /> Lathrop San Joaquin Caun 95330 <br /> 4.INCIDENT DESCRIPTION: <br /> a.DATE: b. TIME (Military): C.SITE: d. CAUSE <br /> 04/25/2011 1630 Industrial Plant Mechanical <br /> e. INJURIES f.FATAIXTY g. EVACUATION h.C:L1»,ANTIP BY- <br /> 0 Yes *No D Yes i No Q Yes •No Responsible Party <br /> <br /> <br /> <br /> <br /> <br /> <br /> k.ON SCENE: b.OTHER ON SCENE: c.OTHER NOTIFIED: <br /> Fire Dept. County CES <br /> d.ADMIN.AGENCY: San Joaquin County)Emergency Serviccs e.SEC.AGENCY: <br /> f. ADDITIONAL COUNTY: g.ADMIN.AGENCY: <br /> h.NOTIFICATION LIST: <br /> DOG Unit: RWQCB Unit: 5B <br /> ®AAICUPA ❑AIR RESOURCES BD ❑DPR ❑Cal MAA HAMA&rMn❑SFM ❑omm <br /> ®DF3-OSPR ❑CAL'1RANS ❑EH PARKS ❑Cel M-LA.PL"S MM ❑USMMS ❑DFG10SPR&= <br /> ®D1SC ❑CDP ❑SMSA ❑Cel EMAREG ❑USCG <br /> ®RWQCB ❑COASTAL COM ❑FEMA ❑OSHA ❑COMP <br /> ®US EPA ❑CDPH-D.O. ❑FOOD&AO ❑PARKS&REC ❑Cohnth <br /> ®USFWS [:IDC* ❑LANDS ❑PUC ❑CO/6.Mnth <br /> CONFIDENTIAL <br /> REMARKS <br /> Vyyrntag.centerr p�.cafrtua.rai.gnv;Itw_F2kCL3s2'A£;01;Df'SC.Ef2�t? tealixom <br />