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IIamrdoug Materials Spill Report - 15-5909 Page 1 of 2 <br /> Governor's Office Emergency Services <br /> Hazardous Materials Spill_Re ort <br /> DATE: 10/07/2015 RECEIVED BY: CONTROL#: <br /> TIME: 1248 Cal OES- 15-5909 <br /> NRC - <br /> La. PERSON NOTIFYING Cal OES: <br /> 1. NAME: 2. AGENCY- 3. PHONE#: 4. Ext: 5. PAG/CELL: <br /> BP <br /> I.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. b.QTY:>=<Amount Measure c.TYPE: d.OTHER:e. f. VESSEL <br /> SUBSTANCE: PIPELINE >=300 <br /> Tons <br /> 1. Unleaded = I Gal(s) PETROLEUM No No <br /> Fuel <br /> 2. = No No <br /> 3. = No No <br /> g. A customer was refueling their vehicle when they noticed a fuel release coming <br /> DESCRIPTION: from the fuel tank. It is believed the release occurred due to a hole in the tank. An <br /> estimated amount of 1 gallon of fuel spilled onto asphalt and on-site personnel <br /> have completed a clean-up. No waterways were impacted. <br /> It. CONTAINED: i. WATER j. WATERWAY: IL DRINKING WATER <br /> INVOLVED: IMPACTED <br /> Yes No None No <br /> 1. KNOWN Unknown <br /> IMPACT <br /> 3. a. INCIDENT LOCATION: 85 East Louise Ave <br /> b. CITY: c. COUNTY: d. ZIP: <br /> Lathrop San Joaquin County 95330 SAN JOAQUIN VALLEY <br /> UNIFIED APCD <br /> 4. INCIDENT DESCRIPTION: <br /> a. DATE: b. TIME (Military): c. SITE: d. REPORTED CAUSE <br /> 10/07/2015 1130 Service Station Unknown <br /> e. INJURIES L FATALITY g. EVACUATION h. CLEANUP BY: <br /> No No No On-Site Personnel <br /> 6. NOTIFICATION INFORMATION: <br /> a. ON SCENE: b. OTHER ON SCENE: c. OTHER NOTIFIED: <br /> None <br /> d.ADMIN. AGENCY: San Joaquin County e. SEC. AGENCY: <br /> Environmental Health <br /> f.ADDITIONAL COUNTY: g. ADMIN. AGENCY: <br /> h. NOTIFICATION LIST: <br /> DOG Unit: RWQCB Unit: <br /> 513 <br /> AA/CUPA,DFG-0SPR,DTSC,RWQCB,US EPA,USFWS,COMP,CO/E-Hlth <br /> 1.ARB: <br /> ********* Contro No: 15-590 ********* <br /> cle a,v . WOZ e dr /v\ waS PrD <br /> Lalacl,e.�. <br /> https://w3.calema.ca.gov/operational/malhaz.nsf/fl 84lal O3c l O2734882563e200760c4a/4... 10/21/2015 <br />