Laserfiche WebLink
From:Cal EMA (State Warning Winter) 9168458910 0•. 412010 20:59 #961 �P.001/001 <br /> California Emergency Management A a <br /> Hazardous Materials Spill Re rt <br /> DATE: 04/14/2010 RECEIVED BY: CONTROL#: <br /> Q <br /> 'TIME: 2051 Cal EMA- Danielle Bird Cal EMA- 10-2373 , <br /> e <br /> OSPR- NRC- <br /> I.a. PERSON NOTIFYING Cal EMA: "J <br /> f 1 <br /> 1. NAME: 2. AGENCY: 3. PHONE#: 4. Ext: 5.PAG/CELL:`'' <br /> Flying;f <br /> I.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:>=< Amoaw Measure e.TYPE: d OTHER: <br /> 1.Diesel = 4 Gal(s) PETROLEUM <br /> 2. _ <br /> 3. _ <br /> e.DESCRIPTION: Due to a malfunction of a gas pump while a customer was pumping gas,diesel was released. <br /> f.CONTAINED: g.WATER h.WATERWAY: i.DRINKING WATER IMPACTED <br /> INVOLVED: <br /> Yes No <br /> j. KNOWN IMPACT <br /> 3. a.INCIDENT LOCATION: 1501 N Jack Tone Road <br /> b.CITY: c.COUNTY: d.ZIP: <br /> Ripon San Joaquin County <br /> 4.INCIDENT DESCRIPTION: <br /> a.DATE: b. TIME (Military): C. SITE: d. CAUSE <br /> 04%14%2010 2015 Service Station Unknown <br /> e. INJURIES f.FAT./k1X1'Y g. EV,A CUAIJON h.CL F:.:><NU.P BY: <br /> On-Site Employees <br /> <br /> <br /> <br /> <br /> 6. NOTIFICATION INFORMATION: <br /> ON SCENE: b.OTHER ON SCENE: c.OTHER NOTIFIED: <br /> City of Ripon Fire Dept. <br /> d.ADMIN.AGENCY: San Joaquin County Emergence e.SEC.AGENCY: <br /> Services <br /> f. ADDITIONAL COUNTY: g.ADMIN.AGENCY: <br /> h.NOTIFICATION LIST: <br /> DOG Unft: RWQCB Unit: 5B <br /> ®AA/CUPA ®USFWS ❑CDPH-D O ❑FEMA ❑Cal EMA REO ❑UMAW ❑OTHER <br /> ®DFO-OSPR ❑AIR RESOURCES BD ❑DOO ❑FOOD&AO ❑OSHA ❑USCG <br /> ®DTSC ❑CALTRANS ❑DPR ❑LANDS ❑PARKS&RFC ❑CO/WP <br /> ®RWQCB ❑CDF ❑EB PARKS ❑Cal E.MAHAZMATUM❑PVC ❑CO/Hlth <br /> ®US EPA ❑COASTAL COM ❑DASA ❑Cel EMA PLANS UMT ❑SFM ❑C./E.Mth <br /> Warningxenter,12�;esxa.gov:R3.RRQ/ E:i'A.0 OV;D'rSCXR;1:grn3J1xom <br /> (rsl o pry .- ." a4w.-,.d�ut%n r,,r��a d . wu.r A4 <br /> wax <br /> Tam y �• <br />