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01-02-2007 16:39 From-OES HQ SAC' "INTO W/C 916-845-8910 T-195 P.002/002 F-065 <br /> ";' �' GOVERNOR'S OFFICE OF <br /> - � -- lSGENCY SERVICES <br /> iasHazardous Materill Report <br /> DATE: 01/02/2007 RECEIVED BY: CONTROL#: <br /> TIME: 1621 OES- Courtland Ems OES- 07-0031 <br /> IOSPR- <br /> <br /> <br /> : <br /> 1. NAME: 2. AGENCY: 3. PHONE#: 4.Ext: 5.PAGICELL; <br /> 2. SUBSTANCE TYPE: <br /> 2,a.SUBSTANCE: b.QTY->�< Amount Measure c.TYPE: d.OTHER: <br /> 1.Motor oil 5 Galls) PETROLEUM <br /> 2. - <br /> 3. <br /> e.DESCRIPTION; Equipment failure caused this spill <br /> f.CONTAINED: g.WATER INVOLVED; h.WATERWAY; i.DRINKING WATER IMPACTED <br /> Yes No No <br /> 3. a.INCIDENT LOCATION: 16888 McKinley Ave <br /> b.CITY: c.COUNTY: d.ZIP- <br /> LaThmp San Joaquin Cotmty 95330 <br /> 4.INCIDENT DESCRIPTION: <br /> a.DATE;12/31/2006 b. TIME (Mo1rarl):1500 c.SITE: Merchant/Bushiess <br /> d. INJURIES# e.FATALS#: f.EVACS#: g.CLEANUP BY: <br /> 0 0 0 Reporring Parry <br /> <br /> <br /> <br /> <br /> <br /> 6. NOTIFICATION INFORMATION: <br /> !a.ON SCENE: b. OTHER ON SCENE: c.OTHER NOTIFIED: <br /> d.ADMIN.AGENCY: san,loaquin County Emcrgency Sarviccs e.SEC,AGENCY: <br /> Y NOTIFICATION LIST: DOG Unit: RWQC73 unit: 5B <br /> nn Corn u USPWS OsIIA <br /> Lf {DFG-OSPR ❑AM RRSOURCFS SD L DOG LJ LANDS rrJ,PARitS&RkC I. USno, <br /> DTSC D CALTAANS L-I EB PARKS ❑0B9 FIAZMAT1JhJ1'f LJ PUC U OTIIIIR <br /> lJ RWQCP L..�CDP -�BMSA ❑OBS PLANS UNIT ❑SFM <br /> C^:1 US PPA U COASTAL COM EI FEMA ❑of s mG ❑USMMs <br />