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0�-30-2008 10:35 From-OES HQ SACRAMENTO W/C 916-845-8910 T-313 P.001/001 F-525 <br /> -;�'• GOVERNOR'S OFFICE OF EMERGENCY SERVICES <br /> Hazardous Materials Spill Report <br /> DATE; 07/30/2006 RECEIVED BY: CONTROL#: <br /> TIME: 1014 0 E- Bob Mcrae OES- 06-4518 <br /> OSPR NRC- 806055 <br /> 1.a. )PERSON NOTIFYING GOVERNOR'S OES: <br /> 1. NAME: 2. AGENCY: 3. PIUONE#: 4.Ext: S.PAG/CELL.: ve <br /> XXX NRC 800-424-8802 <br /> Lb. PERSON REPORTING SPILT.(Ir different from above): <br /> 1. NAME: 2. AGENCY: 3. PHONE#: 4.Ext: 5.PAG/CELL: <br /> Shawn Mendoza ST Services 209-943-5662 <br /> 2. SUBSTANCE.TYPE: Measure c.TYPE: d.OTHER: <br /> 2.a.SUBSTANCE: b.QTY:>=S amount <br /> 1.Gasoline - 155 Gal{5) PE'T'ROLEUM <br /> 2. <br /> 3. <br /> e.DESCRIPTION: A tanker truck drove off with the loading arm still connected to the trunk resulting in gasoline <br /> spilling on the ground. <br /> f.CONTAINED: g.WATER INVOLVED: h.WATERWAY: i.DRINKING WATER.IMPACTED <br /> Yes No No <br /> 3. a.INCIDENT LOCATION: 2941 Nary Dr. d.ZIP: <br /> b.CITY: e.COUNTY: <br /> Stockton San Joaquin County <br /> 4.INCIDENT DESCRIPTION: 0700 �.81T)E; Other <br /> a.DATE: 07/30/2006 b. TIME lM+'�irarV). CLEANUP BY' <br /> d. INJURIES# e.FATALS#: f.F- g.VACS#: U - <br /> 0 0 Unknown <br /> 0 <br /> Same as#i1`PERSON NOTIFYING OES <br /> 5. SUSPIECT'ED RESPONSIBLE PARTY: <br /> NAME: b, AGENCY: C.PHONE#: d.EXT.: <br /> a. <br /> Shawn Mendoza ST Services 209-943-5662 <br /> e.MAIL,ADDRESS: f.CITY; g.STATE: h.ZIP: <br /> 2941 Navy Dr. Stockton CA <br /> 6. NOTIFICATION INFORMATTON: <br /> �a.ON SCENE: b.OTHER ON SCENE: e_OTHER NOTIFIED: <br /> NRC <br /> d.ADMIN.AGENCY: San loac}uin County Emargcncy Services e.SEC.AGENCY: <br /> DOC:Unit: RWQC8 unit; 58 <br /> f.NO{�T�IFICATION LIST.- <br /> L.�'} I I n <br /> IJ AA/CUPA !/JI USYWS DHS-p.0. ROOD—I10 <br /> LANGS PARKS Cc KL�C LS U&!�A V.J USCd <br /> OPG-OSPR ❑mR RESOURCES DD�I DOG L.I ❑U6P01 <br /> DISC ❑CALTRANS ❑B5 PARKS OES HAXMATUVIT ❑PUC ❑OR•HF.R <br /> ®RWQCB ❑cor ❑BMSA L Oe5 PLkNS UNrr I�SFM <br /> US GPA ❑COA�'1•AL COM ❑FEM- 71 on-,R5G L J usMMS Y <br />