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/7 <br /> Frco:Cal EARA (State Warning Center) 9168458910 04/0412011 08;09 #034 P.001.1001 <br /> California Emergency Management Agency <br /> Hazardous Materials Spill Report <br /> DATE: 04/0412011 RECEIVED BY: CONTROL#: <br /> TIME: 0756 Cal EMA- Courtland Ellis Cal EMA- 11-2159 <br /> <br /> <br /> <br /> <br /> 1.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: Amount Measure c.TYPE: d.OTHER: e. VESSEL <br /> '-` >=300 Tons <br /> 1. Sulfuric Acid _ 10 Gal(s) CHEM[CAL d Yes No <br /> 2. = O Yes i No <br /> 3. O Yes • No <br /> s.DESC RII rioN: 'Equipment failure caused this release to the soil <br /> f.CONTAINED: g.WATER h.WATERWAY: i.DRE LAKING WATER IWACTEI) <br /> INVOLVED: <br /> Yes No No <br /> j.KNOWN.IMPACT None <br /> 3. a.INCIDENT LOCATION: 16777 Howland Rd <br /> b.CITY; c.COUNTY: d.ZIP: <br /> Lathrop San Joaquin County 95330 <br /> 4.INCIDENT DESCRIPTION: <br /> a.DATE: b. TIME (military): C.SITE: d. CAUSE <br /> 04/04/2011 0642 Industrial Plant Mechanical <br /> WRI-6 i LFATAIXf V g. EVACITAITON. h.C'LEANUIP BY: <br /> O Yes *No O Yes *No D Yes •No Contractor <br /> <br /> <br /> <br /> <br /> <br /> 6. NOTIFICATION INFORMATION: <br /> Ia. ON SCENE: b.OTHER ON SCENE: c.OTHER NOTIFIED: <br /> San.Joaquin Co OFS <br /> d.ADMIN.AGENCY: San Joaquin County Emergency Services e.SEC.AGENCY: <br /> L ADDITIONAL COUNTY: g.ADMIN.AGENCY: <br /> h.NOTIFICATION LIST: <br /> DOG unit: RWQCB Unit: 5B <br /> CKAMMMA ❑AM RESOURCES BD ❑DOR ❑Cel EMAHA7.MAnM=❑SFM ❑OTHER <br /> ODFG•OSPR ❑CALTRANS ❑EB PARKS ❑Cal EMAPLANS UNn- ❑USMMS ❑DFGIO5PR/MSU <br /> XDTSC ❑CDF ❑EMSA ❑Cd EMAREO ❑USCG <br /> NRWQCB ❑COASTAL COM ❑FEMA ❑OSHA ❑COIVYP <br /> OUS FPA ❑COPH-D.O. ❑FOOD AAG ❑PARKS&RFC ❑Co/111th <br /> ZUSFWS ❑DOG ❑LANDS ❑PUC ®Co18-HI1h <br /> CONFIDENTIAL <br /> Itlntia�s <br /> Warning.centrr{tinps.catetna.ra.g:)v;R RRCWrSC.ER,1q?;rmW1.ram <br /> lqll QA vs <br />