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From:CALIFORHIA STATE WARW NG CNTR 19168458910 10/0412011 15:16 #416 <br />• • <br />California Emergency Management AgiL�o% <br />Hazardous Materials Spill Rei �. <br />P.0011001 <br />DATE: 10/04/20 11 <br />RECEIVED BY: <br />CONTROL#: <br />TIME: 1 X09 <br />Cal EMA - BU -e Tyson <br />Cal EMA - 11-5892 <br />95366 <br />OSPR- <br />NRC - <br /> <br /> <br /> t <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 A2'easure c. TYPE: d. OTHER: e. PIPELINE f. VESSEL <br />'=` >= 300 Tons <br />1. Sulfar Dioxide, = 3-4 Lbs. VAPOR O Yes 9 No Q Yes 0 No <br />2. = Q Yes i No O Yes 0 No <br />3. - O Yes it No O Yes * No <br />g. DESCRII''I'IO N: Check valve failed causing the release, material flowed into nitrogen piping, RP purged ,,Md <br />contained the material using water drums, no clean up required, <br />h. CONTAINED: 1. WATER j. WATERWAY: k DRIlNIONG WATER IMPACTED <br />INVOLVED: <br />Yes No <br />1. KNOWN IMPACT None <br />3. a. INCIDENT LOCATION: 17000 E Iiwy 120 (Franzia Vinery) <br />b. CITY: <br />c. COUNTY: <br />d. ZIP: <br />El Cal EMA HAZMATUNIT ElSFm ❑ OTHER <br />Ripon <br />San Joaquin County <br />95366 <br />❑ Cal EMA PLANS UNIT <br />4. INCIDENT DESCRIPTION: <br />N DISC <br />❑ CDF <br />a. DATE: <br />b. TIME (military): <br />c. SITE: <br />d. CAUSE <br />10/04/2011 <br />1310 <br />MerchanuBusiness <br />Mechanical <br />e. IN.l €MIE' s <br />1'. FATALITY <br />l;..l VA€.€;A l"IO:'a <br />it. .1 V; <br />Q Yes • No <br />Q Yes f No <br />O Yes ! No <br />N/A <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />6. NOTIFICATION INFORMATION: <br />Ia. ON SCENE: b. OTHER ON SCENE: c. OTHER NOTIFIED: <br />San Joaquirt Co OES <br />d. ADMIN. AGENCY: san Joaquin County Funergency Services e. SEC. AGENCY: <br />f. ADDITIONAL COUNTY: g. ADMIN. AGENCY: <br />h. NOTIFICATION LIST: <br />DOG Unit: RWQCB Unit: 5B <br />NAA/CUPA <br />® AIR RESOURCES ED <br />[:1 DPA <br />El Cal EMA HAZMATUNIT ElSFm ❑ OTHER <br />9 DFG-OSPR <br />❑ CALTRA.NS <br />❑ EB FARKS <br />❑ Cal EMA PLANS UNIT <br />❑ USMMS ❑ DFGiOSPR'USU <br />N DISC <br />❑ CDF <br />❑ EMSA <br />❑ Cal EMP. REG <br />❑ USCG <br />N RWQCD <br />❑ COASTAL COM <br />❑ FEMA <br />❑ OSHA <br />❑ C.AVP <br />N US EFA <br />❑ CDPH-D.0 <br />❑ FOOD & Ae <br />❑ PARKS & REC <br />❑ Co)Mth <br />N Usrx'3 <br />❑ DOG <br />❑ LANDS <br />❑ FVC <br />❑ C0/E-Hlth <br />CO,NTMENTIAL <br />REMARKS <br />Vi'ar2En .ten?rr :r�}�x.caierrsw.ra�.�n�; BV�tiS ,siyra}u^s1.nr3�; gtiEsstk!rsat}�.rrr.�c�vp f�s3rcaz.aasiaiiir 3-'rifw . tr : R9 RRC F.F'A.GOa', <br />DTSC'.ER.' gniall.com <br />�� � <br /> <br /> <br /> ! <br />