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a <br /> Froc CALIFORRIA STATE WARNING CNTR 19158458910 06115/2012 11 :11 #342 P.0011002 <br /> Callfomia Emergency Management Agency <br /> Hazardous Materials Spill Report <br /> DATE: 06/15/2012 RECEIVED BY: CONTROL* <br /> TIME: 1105 Cal EMA- Dana Kay Cal EMA- 12-3495 <br /> 10SPR- INRC- <br /> 1jL <br /> PERSON NOTIFYING Cal EMA: <br /> 1. NAME: 2. AGENCY: 3. PHONE#: 4.Eat: 5.PAG/CELL: <br /> Chuck Uuros Cottage Bake 209-810-0147 <br /> 1.b. PERSON REPORTING SPILL(If diffaent from above): <br /> 1. NAME: 2. AGENCY: 3. PHONE#: 4.Eat: 5.PAGICELL: <br /> 2. SUBSTANCE TYPE: <br /> 2.a.SUBSTANCE: b.QTY: Anosw Mlenwe e.TYPE: i OTHER: e. PIPELINE f. VESSEL <br /> >=300 Tons <br /> I.Vegetable or - 25 G81(s) PETROLEW Under o Yes*No Q Yes • No <br /> Compressor Oil investigation <br /> to determine <br /> which prodact <br /> 2. = O Yes*No Q Yes • No <br /> 3. D Yes!No 0 Yes 0 No <br /> g.DESCRFY IONI, It appears oil was staged to be placed in a cage,a release occurred to a dirt lot area. The <br /> release is contained and no water is involved. The cause remains under investigation.A <br /> contractor is enroute for cleanup. <br /> h.CONTAINED: L WATER J.WATERWAY: k.DRINKING WATER IMPACTED <br /> INVOLVED: <br /> Yes NO <br /> L KNOWN IMPACT None <br /> 3. a.INCIDENT LOCATION: I831 South Stockton St <br /> b.CITY: c.COUNTY: d.ZIP: <br /> Lodi San Joaquin County <br /> 4.INCEDENT DESCRIPTION: <br /> a.DATE: b. TATE (wltaory): c.SITE: d. CAUSE <br /> 06/15/2012 0830 Industrial Plant Ubknown <br /> e. II1.IUR FS 1:FATAL.rTY g EVACUATION h.CLEANUP BY- <br /> 0 Yes•No CS Yes i No 0 Yes•No Contractor <br /> S. SUSPECTED RESPONSIBLE PARTY: <br /> a.NAME: b. AGENCY: c.PHONE#. d.EXT.: <br /> Chuck Duros Cottage Bakery 209-8100147 <br /> e.MAIL.ADDRESS: L CITY: g.STATE: h.21p: <br /> 1831 South Stockton St Lodi CA 95230 <br /> b. NOTIFICATION INFORMATION: <br /> �L ON SCENE: b.OTHER ON SCENE: c.OTHER NOTIFIED: <br /> OES <br /> d.ADMIN AGENCY: sun 7oawm comy y amergalsy services, e.SEC.AGENCY: <br /> L ADDITIONAL COUNTY: g.ADMIN.AGENCY: <br /> h.NOTIFICATION LIST: <br /> DOC UNI: RWQCB UM 5B <br /> ®AA/WA ❑AMPMOUR=W ❑APB ❑Cal n AHAWAT01M❑ffiM ❑ws-m <br /> ODFO.OSPR ❑CALTRANS ❑EB PARKS ❑Cal MAK AMB UMT ❑UCM ❑OTHEB <br /> ®� ❑CM1M ❑MaA ❑W WAR;a ❑unam ❑nFa� r <br /> ®RWQM ❑Comm COM ❑FwA ❑OSHA ❑um <br /> ®US FPA ❑mm-1).O. ❑FOOD R AG ❑PARKS d REC ❑cww <br /> ®tp9WB ❑DOO ❑LANDS ❑PUC ❑C.Mth <br /> FUS-FIDF.Na!UL <br />