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E <br /> 04-03-2008 01:41am From-OES LIQ SACRAMENTO W/C 916-645-8810 T-057 P.001/001 F-222 <br /> U' K"ls' GOVERNOR'S OFFICE OF EMER <br /> SERVICES Q40 Hazardous Materials Spill <br /> DATE: 04/03/2008 RECEIVED BY; CONTROL#: <br /> TIML- 1322 OES- Rubor,Rodriguez OES- 08-2535 �� /^�, ; -::) <br /> OSIER- NRC- <br /> 1.a. PERSON NOTIFYING GO'VERNOR'S OES; <br /> 1. NAIVE: 2. AGENCY: 3. PHONE#; 4.Ext: 5.PAGICELL: <br /> Laura Lazzelle City of Stockton,Municipal 209-937-8852 209-423-62144 <br /> Utilities <br /> Lb. PERSON REPORTING SPILL(If different from above): <br /> 1. NAME: 2. AGENCY: 3. PHONE*: 4.Ext; S.PAG/CELT.: <br /> 2. SUBSTANCE TYPE: <br /> 2.a.SUBSTANCE: b.OTY:>" Amount Mrsasure C.TYPES d.OTHER: <br /> 1.Diesel 20 Gal(s) PETROLEUM <br /> 2. - <br /> 3. - <br /> e.DESCRIPTION; Vandals broke inro the Smith Cauls Pumping Facility and stole diesel from the above ground <br /> tank, As a result,some release reached the ground in the containment arca. <br />€ f CONTA1ElVED; g.WATER INVOLVED: h.WATERWAY: h DRINKING WATER IMPACTED <br /> Yes NO <br /> 3. a.INCIDENT LOCATION: 2144,Poneana Drive Q Country Club <br /> b.CITY; c.COUN'T'Y: d.ZIP: <br /> Stockton San Joaquin County 95204 <br /> 4.INCIDENT DESCRIPTION: <br /> a.DAT'F;04/03/2008 b. TIE (MIRwy):00;00 c.SITE: Other <br /> d. INJURIES# e.FATAL$#; f.EVACS#; g.CLEANUP BY.- <br /> 0 0 0 Contractor <br /> Same as#7"PERSON NOTIFYING QHS;f <br /> 5. SUSPECTED RESPONSIBLE PARTY: <br /> a.NAME; b. AGENCY: c.PHONE#: d.EXT.. <br /> Unknown vandals <br /> e.MAIL ADDRESS; f.CITY; g.STATE: h.ZIP: <br /> CA <br /> 6. NOTTPMCATION INFORMATION; <br /> la.ON SCENE: b.OTHER ON SCENE: c.OTHER NOTEF"; <br /> Co OES <br /> d.ADMIN.AGENCY: San 1oaquin County Bmergeney Services e.SEC.AGENCY: <br /> f.NOTIFICATION LIST: DOG ttnit: RWQCB Unit- 5B <br /> AWMA ns�sys --❑pHs a,a ❑MOD&Ac ^'O OSHA M ❑Osco <br /> DFG-0SFR ❑AIR RaWKCFS so❑aoc ❑LAN ❑PAW&ssC ❑u8D0i <br /> LSI DTSC ❑CAVNAMS ❑Pd PACKS ❑QRS HA2MAn= ❑Puc ❑oniwL <br /> Rwocs ❑GDF ❑0h1SA ❑09 KANS UMT ❑SFM <br /> �:�u3 EFA ❑COASTAL COM 0 MU ❑OPS no ❑XJ5MMS <br />