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�. wI <br /> Fron:CALIFORHIA STATE WARNING CNTR 19168458910 05124/2012 09:58 #705 P.0011002 <br /> California Emergency Management Agent <br /> Hazardous Materials Spill Report Ow <br /> DATE: 05/24!2012 RECEIVED BY: CONTROL#: <br /> TIME: 0941 Cal EMA. Blake Tyson Cal EMA- 12-3069 <br /> OSPR- NRC- 1012510 <br /> l.a PERSON NOTIFYING Cal EMA: <br /> 1. NAME: 2. AGENCY: 3. PHONE#: 4.Ext: 5.PAGICELL: <br /> XXX NRC 800-424-8802 <br /> 1.b. PERSON REPORTING SPILL(If different from above): <br /> 1. NAME: 2. AGENCY: 3. PHONE#: 4.Ext: S.PAG/CELL: <br /> Matthew Bradford Robinson Bradford LLP 209-473-6450 <br /> 2. SUBSTANCE TYPE: <br /> 2.a.SUBSTANCE: b.QTY: Ammurr Mefirare c.TYPE: d.OTHER: a PIPELINE L VESSEL <br /> >=< >=300 Tons <br /> 1.Oil-Waste = Urtc Galls) PETROLEUM O Yes 0 No O Yes 0 No <br /> Type <br /> 2. = O Yes *No O Yes 0 No <br /> 3. = O Yes 9 NO 0 Yes 40 No <br /> g.DESCRIPTION: Per NRC report:Report of a former auto shop with a storage trap(Pit)that contains quite a <br /> bit of old and used oil,enough to fill up dnuns,the trap lid has holes in it and when it rains, <br /> the pit overflows and material spills out,owner plans to pour concrete over the pit as <br /> remediation. <br /> h.CONTAINED: I.WATER J.WATERWAY: k.DRINKING RATER IMPACTED <br /> INVOLVED: <br /> Unknown Yes Storm gutter Unknown <br /> L KNOWN IMPACT Uadmown <br /> 3. a.INCIDENT LOCATION: 2151 CountryClub Blvd LLC <br /> b.CITY: c.COUNTY: d.ZKP: <br /> Stockton San Joaquin County <br /> 4.INCIDENT DESCRIPTION: <br /> ATE: h. TIME /Minas/: c.SITE: d. CAUSE <br /> 0800 Merchant/Busine_ss Other <br /> ` Description for Other: <br /> Abandonment <br /> a. WRTRIES f.FATALITY g.E:V WFATION h.CLF ANUP BY: <br /> O Yes 0 No O Yes•No O Yes•No Unknown <br /> S. SUSPECTED RESPONSIBLE PARTY: <br /> a.NAME: b. AGENCY: c.PHONE#: d.EXT.: <br /> Roger Hartley 209.473-6450 <br /> e.MAIL ADDRESS: L CITY: g.STATE: h.ZIP: <br /> 2151 Country Club Blvd LLC Stockton CA <br /> 6. NOTIFICATION INFORMATION: <br /> k.ON SCENE: b.OTHER ON SCENE: c.OTHER NOTIFIED: <br /> d.ADMIN.AGENCY: sari Joaquin County Emergency Saviccs e.SEC.AGENCY: <br /> f. ADDITIONAL COUNTY: g.ADMIN.AGENCY: <br /> h.NOTIFICATION LIST: <br /> qDOG Unit RWQCB UNt: 5B <br /> p0Ipp��AP/COPA ❑AniR60MMSD ❑DPa ❑Cal II.GtLirALATONNIT❑6FM ®Cw/LMA <br /> [Rterok ❑CALSANJa ❑Ea PAB%a ❑CeIFMAPI.ANa[MarR ❑um ❑0 <br /> 0DraC ❑CALFIDE []ELISA ❑CaIEMA ❑OSMaa ❑DFO/OI@Prra4C <br /> s BWQ'm, r®WASIA m ❑FEMA ❑ocrm ®DsCV <br /> NMEPA RMPHDO ❑FJOD&Ao RPA%Ea&M 0 <br /> [Rrrros ❑Doer RUoTD0 ❑PDO N� <br /> COh71DB TIL wss w attorney Mred by the fornrerresidan of tris,p ipeny.RP was the landlord and contact d for the wspecte <br /> REMARKS: .ble party is an altnmgx pl.number. <br />