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FrouCal EISA (State Warning Center) 9168458910 08/20J2010 12:44 #286 P.0011001 <br /> California Emer enc <br /> g y Agement Agency <br /> Hazardous Materials Spill Report <br /> DATE: 08/20/2010 RECEIVED BY: CONTROL-#: <br /> TIME: 1239 Cal EMA- Timothy Britt Cal EMA- 10-4989 D <br /> OSPR- NRC- �;��?:, 1 <br /> <br /> <br /> Lb. PERSON REPORTING SPILL(If different from above): <br /> 1. NAME: 2. AGENCY: 3. PHONE#: 4.Ext: 5.A� IjC ` <br /> 2. SUBSTANCE TYPE: <br /> 2.a.SUBSTANCE: b.QTY:>=< Amount Measure c.TYPE: d OTHER: <br /> 1.Diesel = 1 Gal(s) PETROLET-M <br /> 2. _ <br /> 3. _ <br /> e.DESCRIP171£II : RP states approximately one gallon of diesel was released to the metal frame and concrete <br /> pad of a generator. No waterways or soil was affected. <br /> L CONTAINED: g.WATER h.WATERWAY: i.DRINKING WATER IMPACTED <br /> INVOLVED: <br /> Yes No <br /> j.KNOWN IMPACT None <br /> 3. a.INCIDENT LOCATION: 16888 McKinley fkve <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 /> 08/20/2010 1200 Merchant/Dusiness Mechanical <br /> e. INJURIES 1.FALT"U"l.TY g. EVACUATION h. CLEANTiP BY: <br /> Reporting Party <br /> (�..3�f15. <br /> <br /> <br /> <br /> 6. NOTIFICATION INFORMATION: <br /> �a.ON SCENE: b.OTHER ON SCENE: c. OTHER NOTIFIED: <br /> San Joaquin County Health <br /> d.ADMIN.AGENCY: San Joaquin County e.SEC.AGENCY: <br /> Emergency Services <br /> f. ADDITIONAL COUNTY: g.ADMIN.AGENCY: <br /> h.NOTIFICATION LIST: <br /> DOG Unit: RWQCB Unit: 5B <br /> ®AA/CUPA ®USFWS ❑CDPH-D.O. ❑FEMA ❑Cal EMAREG ❑USMMS ❑OTHER <br /> ®DFG-OSPR ❑AIR RESOURCES BD ❑DOG ❑FOOD&AG ❑OSHA ❑USCG <br /> ®DISC ❑CALTRANS ❑DPR ❑LANDS ❑PARRS&REC ❑Co/WP <br /> ®RWQCB ❑CDF ❑EB PARKS ❑Cal EMAHAZMATut=❑PUC ❑C,,/Hlth <br /> ®US EPA ❑COASTAL COM ❑m&A ❑Cal EMAPLANS UNIT ❑SFM ❑Co/E-Hlth <br /> CON IDENIIAL <br /> RFn'UkRXs: <br /> 'V anft;.centerg,ms.ea.gov,R-9--RRC@EP A GON',DTSf'.Erbr guadx0m <br />