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From:Cai EMA (State Warning Center) 9188458910 02/22/2011 17:17 #2 4 P.0011002 <br /> i <br /> California Emergency Management Age � <br /> Hazardous materials Spill Repo <br /> DATE: 02/22/2011 RECEIVED BY: CONTROL#: / ) <br /> TIME: 1707 Cal EMA- Ruben Rodriguez Cal EMA- 11-1092 L J <br /> OSPR- NRC• <br /> La. PERSON NOTIFYING Cat EMU: <br /> 1. NAME: 2. AGENCY: 3. PHONE##: 4.Ext: 5.PAG/CELL: <br /> Alex Steele PG&E 209-337.8902 209-736-6426 <br /> l.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 e.'TYPE: d.OTHER: e. VESSEL <br /> '-` >=300 Tons <br /> 1.'Mineral Oil/268 Gal(s) PETROLEUM O Yes No <br /> PPM PCIS <br /> 2. O Yes No <br /> 3. - 0 Yes 0 No <br /> r.DESE'RRITION: An older pole-top ir,nsformer malfunctioned causing this release to asphalt,concrete,and <br /> I <br /> dirt in the parking lot. <br /> f.CONTAINED: g.WATER h.WATERWAY: i.DRINI KINNG WATER IMPACTED <br /> INVOLVED: <br /> Yes No <br /> j.KNOWN VdPACT <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. TIMI; (Military): C.SITE: d. CAUSE <br /> 02/21/2011 0959 Industrial Plant Cather i <br /> Description for Other:.Equipment <br /> failure <br /> �. L'43L1RIES f.FATALITY n. EVACUATION h. CLEA.i'I.'Y BY. <br /> 0 Yes *No Q Yes r No C Yes *No Contractor <br /> 5. SUSPECTED RESPONSIBLE PARTY: <br /> a.NAME: b. AGENCY: c.PHONE#: d.EXT.: <br /> Alex Steele PG&E 209-337-8902 <br /> e.MAIL ADDRESS: f.CITY: g.STA'T'E: h.ZIP: <br /> 1108 Murphy's Grade Pd Angel's Camp CA 95222 <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 e.SEC.AGENCY: ! <br /> Emergency Services <br /> f. ADDITIONAL COUNTY: g.ADMIlV.AGENCY: <br /> h.NOTIFICATION LIST.- <br /> DOG <br /> IST:DOG Unit: RWQCB Unit: 5B <br /> ®AAICUPA ®USnWS ❑CDPH-D.O. ❑FBMA ❑Cal EMAREG ❑USMMS ❑On WR <br /> ®DFG-OSPR ❑AIRRESOURCES BD ❑DOG ❑FOOD&AO ❑OSHA ❑USCG ❑DMOSPRIMSU <br /> S DTSC ❑CALTEMS ❑DPR ❑LANDS ❑PARKS&REC ❑CorwP <br /> O RWQCB ❑CDF ❑EB PARKS ❑Cal EMA HAZNL TUNnr❑PUC ❑C.Mah <br /> ®US EPA ❑COASTAL COM ❑EMSA ❑Cal EMA PLANS UfM ❑SFM ❑ColE•Alth <br /> CONFIDENTIAL <br /> NTIAL <br /> RENW?KS: <br /> 'Worlliiig.center(a)ips.calemA.ca.gov,R9 RRC fU.GUV:DTSC.LRagmatt.cwa <br />