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California Emergency Management Agency <br /> Hazardous Materials Spill Report <br /> DATE: 02/22/2011 RECEIVED BY: [NRC <br /> ONTROL#: <br /> TIME: 1707 al EMA- 11-1092 <br /> - <br /> LPERSON NOTIFYING Cal EMA: <br /> 1. NAME: 2. AGENCY: 3. PHONE#: 4. Ext: 5. PAG/CELL: <br /> PG&E <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:>=< Amount Measure c.TYPE: d. OTRER: e. VESSEL <br /> >=300 Tons <br /> 1.Mineral Oil/268 = 1-5 Gal(s) PETROLEUM No <br /> ppm PCB <br /> 2. = No <br /> 3. = No <br /> e. DESCRIPTION: An older pole-top transformer malfunctioned causing this release to asphalt, concrete, <br /> and dirt in the parking lot. <br /> L CONTAINED: g.WATER h.WATERWAY: LDRINKING WATER <br /> INVOLVED: IMPACTED <br /> Yes No <br /> j. KNOWN <br /> IMPACT <br /> 3. a. INCIDENT LOCATION: 124 North E Street <br /> b. CITY: c. COUNTY: d. ZIP: <br /> Stockton San Joaquin County <br /> 4. INCIDENT DESCRIPTION: <br /> a.DATE: b. TIME (Military): c. SITE: d. CAUSE <br /> 02/21/2011 0959 Industrial Plant Other <br /> Description for Other : Equipment <br /> failure <br /> e. INJURIES E FATALITY g. EVACUATION h. CLEANUP BY: <br /> No No No Contractor <br /> 6.NOTIFICATION INFORMATION: <br /> a. ON SCENE: b. OTHER ON SCENE: c. OTHER NOTIFIED: <br /> County OES and ENV Health <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 /> AA/CUPA,DFG-OSPR,DTSC,RWQCB,US EPA,USFWS <br /> CONFIRMATION <br /> REQUEST: <br /> ********* Control No• 11-109r* ******* <br /> p f - sol ase -6 aea^ VP �qo 6�I• seed 61+. �kAlY6 �d <br /> Created by. Warning Center on: 02/22/201105:07:46 PM Last Modified by. Warning Center on: 02/22/201105:10:44 PM <br /> us 113 ,�,e oauLe + �x� -(-o sc�,,�- fry �� <br /> 6f it- <br /> ` <br /> &-A S`� &t WkA c s Biu �e <br /> http://www.oes.ca.gov/operational/malhaz.nsFf184l a103c lO2734882563e20076Oc4a/2da6ce7fc3afd4628825784000063466?OpenDocument <br />