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02-08-2007 10:39 From-OES HO SACRAMENTO W/C 918-845-8910 T-218 P 001/001 F-481 <br /> s� ¢..!�;���' GOVERNOR'S OFFICE OF EMERGENCY SE=RVICES <br /> Hazardous Materials Spill Report <br /> E'IDATIE1, /08/2007 RECEIVED BY:025 OES- Dacia Young OES- 07-08 8 <br /> OSPR- 1VRC <br /> l,a. PERSON GOVERNOR'S OFS: <br /> 3. PHONE#: A.Ext: 5.PACT/CELL; <br /> 1. NAME: 2. AGENCY: <br /> Brett Coulson Headwaters Resources 209 639 1211 <br /> l.b. PERSON REPORTING SPILL(If different fYom above): <br /> 1. SAME, 2. AGENCY: 3. PHONE#: 4.Ext: S.PAG/CELL: <br /> 2. SUBSTANCE TYPE: <br /> 2.a.SUBSTANCE: b,QTY:>=-c APHOURI NiPaiure c.TYPE: d.OTKF-R: <br /> 1.Fly Ash{coal ash) w 10,000 Ton(s) UNSPECIFEE Organic <br /> D Green <br /> Substance f <br /> 2. = p <br /> 3, <br /> e.DESCRIPTION: Pressure on concrete wall collapsed the wall to the wherehouse on the west side,south end of <br /> the warehouse.Material spilled out on to d--te main line.The business owns their own railcars to assist with transport <br /> of the product to warehouse. Six cars derailed,two cars on its side.All cars were empty.A dump truck is on scene <br /> for removal. <br /> I <br /> f.CONTAINED: g.WATER INVOLVED: h.WATERWAY: i,DRINKING WATER IMPACTED <br /> No <br /> Yes No <br /> 3. a.INCIDENT LOCATION: 2025 West Hazleton d.ZYI', <br /> b.CITY: c.COUNTY: <br /> Stockton San Joaquin County 45203 <br /> 4.INCIDENT DESCRIPTION: <br /> . a.DATE:02109/2007 >b: TIME (Military):0830 C.SMI- Road <br /> d. IiV.IURITS# e.FATALS#: f.EVACS#: g.CLEANUP BY: <br /> 0 0 0 Reporting Party <br /> Same as#rt."PERSON N07IFYING OES"i <br /> 5, SUSPECTED RESPONSIBLE PARTY: <br /> a.NAME: b. AGF-NCY- c.PHONE#: d.EXT.: <br /> Headwaters Resources 2096391211 <br /> e.MAIL ADDRESS: f.CITY: STATE: h.ZIP: <br /> CA <br /> 6. NOTMCATION INFORMATION: c.OTHER NOTA IED: <br /> 12.ON SCENE: b.OTHER ON SCENE: <br /> Co OES <br /> d.ADMIN,AGENCY: San Joaquin Coun[y Fina'$Clcy Services e.SEC.AGENCY: <br /> f.NOTIFICATION LIST: YiWQCTit3nit: 53 <br /> pool) <br /> DOG Qni�' <br /> AAl <br /> in!liSFWS I AHS-17.0. Ll P6opool)&AC 1511A <br /> CU PA U USCG <br /> pPq-OsPR ❑AIR R£SOURCPS HD{❑DDG {❑'LANA$ lr-}1 PAIu`S&RPC ❑I ll5170i <br /> C>DTSC ❑I^�'c—LT"ns J ro rARxs rL�411S HAYMAT[,'rr,T 1�Puc L OTHER <br /> RWQCQ a CDF L 2MSA 1-�OkS PLAN117HST Ir—�I SAM <br /> �I us F?A ❑COASTAL COM ❑PENIA oris RY.ci L.J U$M1:MS <br />