Laserfiche WebLink
From:CALIFORHIA STATE WARNING rNTR 19168458910 04121011 16:26 #354 P.001/001 <br /> California Emergency Management Agency <br /> Hazardous Materials Spill Report <br /> DATE: 04/21/2011 RECEIVED BY: CONTROL#: D <br /> TIME: 1617 Cal EMA- Bob Mcrae Cal EMA- 11-2533 <br /> OSPR- NRC ,JM- <br /> <br /> <br /> PC <br /> l.b. PERSON REPORTING SPILL(If different from above): <br /> 1. NAME: 2. AGENCY: 3. PHONE#: 4.Ext: 5.P /CE <br /> 2. SUBSTANCE TYPE: <br /> 2.a.SUBSTANCE: b.QTY: Amount Measure e.TYPE: d.OTHER: e. VESSEL <br /> >=< >=300 Tons <br /> 1. Sulfuric Acid < 2 Gal(s) CHEMICAL O Yes ♦ No <br /> 2. = O Yes 0 No <br /> 3. = O Yes 0 No <br /> e.DESCRIPTION: An employee was transferring between totes and a coupling became disconnected,causing <br /> the spill. <br /> E CONTAINED: g.WATER h.WATERWAY: i.DRiNIaNG WATER IMPACTED <br /> INVOLVED: <br /> Yes No No <br /> j.KNOWN IMPACT None <br /> 3. a.INCIDENT LOCATION: 3028 Navy Drive <br /> b.CITY: c.COUNTY: d.ZB': <br /> Stockton San Joaquin County 95206 <br /> 4.INCIDENT DESCRIPTION: <br /> a.DATE: b. TIME (Military): c.SITE: d. CAUSE <br /> 04/21/2011 1542 Other Unknown <br /> e. INJURIES L I ATA.LrrY g.EVACUATION h.CLEANUP BY: <br /> O Yes *No O Yes *No O Yes *No Reporting Party <br /> <br /> <br /> <br /> <br /> <br /> 6. NOTIFICATION INFORMATION: <br /> Ia.ON SCENE: b.OTHER ON SCENE: c.OTHER NOTIFIED: <br /> Cowry OES <br /> d.ADMIN.AGENCY: San Joaquin County Emergency Services e.SEC.AGENCY: <br /> f. ADDITIONAL COUNTY: g.ADMIN.AGENCY: <br /> h.NOTIFICATION LIST: <br /> DOG Unit: RWQCB Unit: 5B <br /> 0AA/CUPA ❑AR2RES ozcww ❑DPR ❑CelESL1HAZMAElSEM ❑OiHfiR <br /> ®DFO-OSPR ❑CALIRANS ❑Ea PARS ❑CeIEMAPLANSU ❑U564.SS ❑DFO/OSPRUSU <br /> ®MC El MFEl EtdaA 11 CW EMAREO El USCG <br /> ®RWQCS ❑COASTAL COM ❑FEMA ❑OSHA ❑C./ <br /> ®USEPA ❑CDM-DO, ❑FOOD&AG ❑pARICS&REC ❑Co/ <br /> ®URFWS 11 DOG ❑SANDS ❑PUC ❑C./EMa <br /> CONFIDENT AL <br /> REMARKS <br /> Warningxmter@apsxaiema.w.gov;R9_RRCAFPA.G0V:DTSC.ER@Zmail.wm <br />