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eC7fN-)LA_ s� From-CES NO SACRAMENTO W/C 916-845-8910 T-619 0.601/001 F-356 <br /> ,E. GOVERNOR'S OFFICE 4F EMERGENCY <br /> ®r— <br /> SERVICES <br /> ...�..� Hazardous Materials Spit] Report <br /> STENIE! <br /> 72048 TOES <br /> EIVED BY: CONTROL#: <br /> L PER1035 - Dana Petersen OES- 08-4962 <br /> R. NRC- 876485 <br /> >E.a. PERSON NOTIFYING GOVERNOR'S OES: <br /> 1. NAME: 2. AGENCY: 3. PHONEM 4.Ext: 5.PAG/CELL: <br /> XXX NRC 1-800-424-8802 <br /> 1.b. PERSON REPORTING SPILL(If different irortr above): <br /> I. NAME: 2. AGENCY: 3. PHONE##: 4.Ext: 5.PAG/CELL- <br /> Michael Spence Village West Marina 209-951-1551 <br /> 2. SUBSTANCE TYPE: <br /> 2.a.SUBSTANCE: b.QTY:?=S Ampant ffmare c.TYPE: 0.OTHER: <br /> 1.POTEN77AL - 0 unknown UNSPECIFIE <br /> UL EASE D <br /> 2. = <br /> 3. <br /> e.DESCRIPTION: *****POTENTIAL RELEASE*****Per NRC report, "A vessel sank at the pier due to <br /> unknown causes. No material has been released at this time. Boom deployed,pads deployed,salvage contractor has <br /> been contacted by vessel owner. <br /> f.CONTAINED: g.WATER INVOLVED: h.WATERWAY: i.DRINKING WATER IMPACTED <br /> Unlmown Yes Dcl%- 14 anile Slough No <br /> 3. a.INCIDENT LOCATION: 6649 Embarcadero Drive <br /> b.CITY; c.COUNTY; d.ZIP: <br /> Stockton San Joaquin County i <br /> 4 ' <br /> 4.INCIDENT DESCRIPTION: <br /> a.DATE-07/0712008 b. TIME (Military):0930 C.SITE: Waterways <br /> d. INJURIES# e.FATAL$#; f.EVACS#: g.CLEANS BY: <br /> 0 0 0 Contractor <br /> Sarre as 41"PERSON NOTIFYING OES"I <br /> 5, SUSPECTED RESPONSIBLE PARTY; <br /> a.NAME: b. AGENCY: c.PHONE##: d.EXT.: <br /> Jack Raney 209-477-8481 <br /> e.MAIL ADDRESS: f.CITY: g.STATE: h.ZIP: <br /> 9230 Whitewater Lane Stockton CA 95219 <br /> 6. NOTIFICATION INFORMATION: <br /> �a.ON SCENE: b.OTHER ON SCM: c.OTHER NOTIFIED: <br /> NRC <br /> d.ADMIN.AGENCY: San Joaquin County 13mes3cncy Services e.SEC.AGENCY- <br /> f.NOTIl4'ICATION LIST: DOC unit: I� r I RWQCa Gbit! 5B <br /> `I�`IJ�nA CUPA ©u9FW5 �I DHS-D D. 17 FOOD&AQ L[J OSHA r�I USCG <br /> Ox iOP&OS"F Lr^�ASR k SOVILCO 19A LJ POG X LANDS L^J PARKS&RFC Lr.J ORD01 <br /> �:�,.'-�DISC D CAITRANS 7 I HB PARKS ❑OPS K&ZMATUNIr LI Fvc OTpER <br /> U RWQCH U CDr L.IBMSA ❑pasPLANSLmT ❑SrM <br /> I'j�.v cr.. Q c:o..xTwL CSM El MMA �..J ons neo ❑wMM <br />