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From:CALIFORHIA STATE WARNING rNTR 19168458910 02/17/2012 19:58 4 P.001/002 <br /> 4 <br /> California Emergency Management Agen <br /> Hazardous Materials Spill Report <br /> DATE: 02/17/2012 RECEIVED BY: CONTROL#: ` <br /> TIME: 19.36 Cal EMA- Tim Tribble Cal EMA• 12-4447 <br /> OSPR- NRC- ` ? <br /> La. PERSO al <br /> NAME: 2. AGENCY: 3. PHONE#: 4.Ext: 5.PAG/CELL: <br /> Rich Gossett BP 714-519-1423 <br /> Lb. PERSON REPORTING SPILL(If different froin above)- <br /> 1. NAME: 2. AGENCY: 3. PHONE#: 4. Ext: 5.PAG/CELL: <br /> 2. SUBSTANCE TYPE: <br /> 2.a.SUBSTANCE: b.QTY: AmOUnt Measure e.TYPE: d.OTHER: e. PIPELINE f. VESSEL <br /> '-` >=300 Tons <br /> 1. Gasoline - 1. Qt.(S) PETROLEUM O Yes ♦No n Yes 0 N- <br /> 2. - O Yes •No O Yes * No <br /> 3. = O Yes 0 No O Yes 0 No <br /> g. 1)ESCRIPTION: :Per the caller a customer topped off the their gas tank causiti,,the tank.to overfill. Station <br /> personnel used absorbent to clean up the spill and disposed of the absorbent in the nazardous <br /> waste container on the site. <br /> h. CONTAINED: i.RrATER j.WATERWAY: k.DRINKING NATER INIPACTEL <br /> INVOLVED: <br /> yes No <br /> 1. KNOWN IMPACT ivv1,� <br /> INCIDENT LOCATION: 3212 N. California <br /> b. CITY: c. COUNTY: d.ZIP- <br /> Stockton San Joaquin County <br /> 4.INCID <br /> <br /> x,rr, <br /> e. INl-€"!:RIDS f FAT:+,111 `Y g—EV'AC'€DATION Ie. CI::E!-0-7'UPBY: <br /> O Yes 9 No O Yes *No O Yes *No Station Personnel <br /> SUSPECTED RESPONSIBLE PARTY: <br /> a.NAME: b. AGENCY: c.PHONE#: d. EXT.: <br /> UnKnow. <br /> e.NIAIL ADDRESS: f.CITY: g.STATE: h.ZIP: <br /> C., <br /> 6. NOTIFICATION INFORMATION: <br /> Ia. ON SCENE: b. OTHER ON SCENE: c.OTHER NOTIFIED: <br /> San Joaquin County OES, San <br /> . aquin County Sheriff, Stockton PD, <br /> San Joaquin CU'PA <br /> d.ADMIN.AGENCY: San Joaquin County Emergency Services e.SEC.AGENCY: <br /> f. ADDITIONAL COUNTY: g.ADMIN.AGENCY: <br /> h.!NOTIFICATION LIST: 44, <br /> DM;Unit; RWQCB Unit: 5B <br /> ®AA/CUPA ❑AIR RESOURCES BD ❑DPR ❑Cal EMA HAZMATUNIT❑SFM ❑Co/E-Hlth <br /> ®DFG-OSPR ❑CALTRANS ❑EB PARKS ❑Cal EMA PLANS UNrr [:IUCSB ❑OTHER <br /> ®DTSC ❑CxjUzF ❑EMSA 4--]Cal EMAREG ❑USMMS ❑DFG/OSPR/MSU <br /> ®RWQCB ❑COASTAL COM ❑FEMA ❑OSHA ❑USCG <br /> ®US EPA ❑CDPH-D.O. ❑FOOD&AG ❑PARKS&REC ❑Co/WP <br /> CR USFWS ❑DOG ❑LANDS ❑PUC ❑Co/Hlth <br /> CONFIDENTIAL. <br /> REMARKS: <br /> F1'arninr.center(ri�ops.caiema.ca.gor;R9_RKC(fiF;Y�.t)O4';1)TSC.ER',4%m2ii.ccnn <br />