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F,rom:C.a.1 EMA (State Warning -nter) 9168458910 0, J12009 11 :23 #543 P.001/001 <br /> California Emergency Managemen y <br /> Hazardous Materials Spill IVC <br /> D <br /> DATE: 06/10!2009 RECEIVED BY: CONTROL#: <br /> TIME: 1110 Cal EMA- Timothy Britt Cal EMA- 09-425 <br /> OSPR- NRC - <br /> La. PERSON NOTIFYING Cal EMA: ` � r <br /> 1. NAME: 2. AGENCY: 3. PHONE#: 4.Ext: 5.PAG�> L)�~" <br /> Johnson Controls <br /> Lb. 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 Measure c.TYPE: d.OTHER: <br /> 1.Diesel = l0 GaI(s) PETROLEt^.1 <br /> 2. _ <br /> 3. <br /> e. RP states that a mechanical problem caused the release of diesel to a parking Iot. The diesel <br /> DESCRIPTION: flows toward and around a storm drain,unknown if the diesel entered the storm drain. <br /> f. CONTAINED: g.WATER INVOLVED: h.WATERWAY: i.DRINKING WA'rER Li PACTED <br /> Yes Unknown Storm drain Unknown <br /> j.KNOWN Unknown <br /> IMPACT <br /> 3. a.INCIDENT LOCATION: Flying J 1501 North Jack-tone Road <br /> b. CITY: c. COUNTY: d.ZIP: <br /> Ripon San Joaquin County 95366 <br /> 4.INCIDENT DESCRIPTION: <br /> a.DATE: b. TIME (Military): c.SITE: d. CAUSE <br /> 06/10/2009 0500 Service Station Mechanical <br /> e. INSURII`tii1 f. F ATALS 00 g. EVACS#: It.CLEA NI"P;1337: <br /> 0 0 0 Unknown <br /> Same as#1."PERSON NOTIFYING Cal EMA" <br /> ....1----------.._.................--.............................. <br /> <br /> <br /> <br /> <br /> <br /> <br /> 6. NOTIFICATION INFORMATION: <br /> �a.ON SCENE: b. OTHER ON SCENE: c. OTHER NOTIFIED: <br /> San Joaquin County Environ Hlth <br /> d.ADMIN.AGENCY: San Joaquin County Emergcncy e.SEC.AGENCY: <br /> Services <br /> f. ADDITIONAL COUNTY: g.ADMIN.AGENCY: <br /> b.NOTIFICATION LIST: <br /> DOG Unit: RWQCB Unit: 513 <br /> ®AWCUPA ®USFWS (ECDPH-D.O. ❑FEMA ❑Cal EMA REO ❑USMMS ❑OTHER <br /> ®DFO.OSPR ❑AIR RESOURCES BD ❑DOO ❑FOOD&AG ❑OSHA ®USCO <br /> ®DTSC ❑CALTRANS ❑DPR I-ANDS ®PARKS&REC ❑COMP <br /> ®RWQCB ❑CDF ❑EB PARKS ❑Cal EMAHAZMATUNrr❑PUC ❑Co/HLLh <br /> ®US EPA ®COASTAL COM ❑EMSA ❑Cal EMA PIANS UN7 ❑SFM ❑Co/E-HILT <br />