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11/30/2011 WED 16:45 FAX 2094683433 SJC EHD 0001 <br /> *** FAX TX REPORT *** <br /> TRANSMISSION OK <br /> JOB NO. 4461 <br /> DESTINATION ADDRESS 99'536268 <br /> PSWD/SUBADDRESS <br /> DESTINATION ID OBS <br /> ST. TIME 11/30 16:64 <br /> USAGE T 00' 30 <br /> PGS. I <br /> RESULT OK <br /> From:CALIFORHIA STATE WAM ING CNTR 19168458910 11/30/2011 16;28 #153 P.0011001 <br /> California Emergency Management Agency <br /> Hazardous Materials Spill Report <br /> DATE: 11/30/2011 RECEIVED BY: 'CONTROL#: <br /> Tl\i 4E: 1617 Cat EMA• . Timothy Britt Cal Elv1A- 11-7100 <br /> OSPR• NRC• 996860 <br /> l.a. PERSON NOTIFYING Cal EMA: - <br /> 1. NAME: 2. AGENCY: 3. PHONE#: 4.Ext: S.PAGJCELL: <br /> Kirk Lund Pacific Ethanol 209-235-0370 6009 <br /> l.b. PERSON REPORTING SPILL(If different from above): ' <br /> 1. NAME: 2. AGENCY: 3. PHONE#: 4.Ext: S.PAG/CELL: <br /> i <br /> 2. SUBSTANCE TYPE: <br /> 2.a.SUBSTANCE: b.QTY: Amount viewire c.TYPE: d.OTHER: e. PIPELBNE E VESSEL <br /> >=` >=300 Tons <br /> 1.Ammonium - 375 Gal(s) CHEMCAL O Yes 0 No O Yes ♦ No <br /> ITydroxide 29-A <br /> Z: = O Yes •No O Yes 0 No <br /> 3. = O.Yes •No O Yes • No <br /> i <br /> -g.DESCRIPTION: ISP?states that while unloading a truck the storage hails was overfilled. The release was to <br /> concrete secondary contaimnent. No waterways were impacted. <br /> h.CONTAINED: 1.WATER j.WATERWAY: it.DRINKING WATER IMPACTED <br /> INVOLVED: <br /> Yes Vo <br /> 1.KNOWN IMPACT None <br /> 3. n.INCIDENT LOCATION:.3028 Navy Drive <br /> b.CITY: c.COUNTY: d.ZIP: <br /> Stockton San Joaquin County 95'06 <br /> 4.INCIDENT DESCRIPTION: <br /> a.DATE: b. TIME (Military): 0.SITE: d. CAUSE ' <br /> 11/30/2011 1505 .Industrial Plant Overflow <br /> e. INJURIFS 1. FATALITY g.EVACUATION IL CLEANUP BY: <br /> O Yes *No O Yes *No O Yes *No Reporting Party ' <br /> 5. SUSPECTED RESPONSIBLE PARTY; ; <br /> a.NAME: b. AGENCY: c.PHONE#: d.EXT.: <br /> Pacific Ethanol/Airgas 209-235-0370 6009 <br /> e.MAIL ADDRESS: f.CITY: g.STATE: h.ZD': <br /> 3028 Navy Drive Stockton CA 95206 I <br /> 6. NOTIFICATION INFORMATION: j <br /> In.ON SCENE: b.OTHER ON SCENE: a OTHER NOTIFIED: <br /> d.ADMIN.AGENCY: san roa*in County Em«gmcy smiccs e.SEC.AGENCY: <br /> L ADDITIONAL COUNTY: g.ADMIN.AGENCY: I <br /> It.NOTIFICATION LIST: t <br />