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From:OES 9168458910 1,43/2008 22:04 #941 P.001/001 <br /> 0 l.; S <br /> GOVERNOR'S OFFICE O D <br /> SERVICE <br /> Hazardous Materials i <br /> N:n�xyaM+bo. <br /> DATE: 12/03/2008 RECEIVED BY: CONTROL#: :Q <br /> TIME: 2146 OES- Darren Mitchell OES- 08-8649 �! <br /> OSPR- NRC- <br /> La. <br /> RC-La. PERSON NOTIFYING GOVERNOR'S OES: <br /> 1. NAME: 2. AGENCY: 3. PHONE#: 4.Ext: 5.PAG/CELL: <br /> ERTS <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 Measwe e.TYPE: d.OTHER: <br /> 1. Diesel - 100 Gal(s) PETROL EUIt4 <br /> 2. _ <br /> 3. _ <br /> e. A semi truck was involved in a collision that ruptured the saddle tank spilling the product onto <br /> L)ESL;RW TO V: asphalt and soil. <br /> f.CONTAINED: g.WATER INVOLVED: h.WATERWAY: i.DRINKING WATER POPACTED <br /> Yes No <br /> 3. a.INCIDENT LOCATION: Flying J Truck Stop HWY 99 at the Jackson Street Exit <br /> b.CITY: c.COUNTY: d.ZIP: <br /> Ripon San Joaquin County <br /> 4.INCIDENT DESCRIPTION: <br /> a.DATE: b. TIME (Military). c.SITE: <br /> 12/03/2008 2130 Merchant/Business <br /> d. IN.TUTUES11 e.F,k- TAI:S,S: f. EVAC'S ff: g.C LE INUP BY: <br /> 0 0 0 Contractor <br /> Same as#1."PERSON NOTIFYING OES" <br /> ........................................................................ <br /> <br /> <br /> <br /> <br /> <br /> <br /> 6. NOTIFICATION INFORMATION: <br /> k.ON SCENE: b.OTHER ON SCENE: c.OTHER NOTIFIED: <br /> Fire Dept. <br /> d.ADMIN.AGENCY: San Joaquin County FsneWncy e.SEC.AGENCY: <br /> scnvices <br /> f. ADDITIONAL COUNTY: g.ADMIN.AGENCY: <br /> h.NOTIFICATION LIST: <br /> DOG Unit: RWQCB Unit: 5B <br /> ®AA/CUPA ®USFWS ❑CDPH-D O ❑FEMA ❑OES REO ❑USMMS ❑OnIER <br /> ®DFO.OSPR ❑AIR RESOURCES BD❑DOG ❑FOOD&AO ❑OSHA ❑USCO <br /> ®DISC ❑CAIMMS ❑DPR ❑LANDS ❑PARKS R REC ❑Co/WP <br /> ®RWQCB ❑CDF ❑EB PARKS ❑OES WSMATUMT'❑PUC ❑C.Mith <br /> ®US EPA ❑COASTAL COM ❑EMSA ❑OES PLANS UNrf ❑SFM ❑Co/E-Hlth <br />