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'p P4V I,N, SAN JOAQUIN COUNTY -OFFICE OF EMERGENCY SERVICES <br /> HAZARDOUS MATERIALS DIVISION <br /> 222 East Weber Avenue,Room 610, Stockton, CA 95202 <br /> .�q �`P <br /> Telephone (209)468-3969 <br /> CrFOR <br /> ADDENDUM TO <br /> CALIFORNIA HAZARDOUS MATERIALS INCIDENT REPORT <br /> Date Incident Occured Time Incident Date At Scene Time At Scene SJOES Incident No. <br /> Occured <br /> 5/16/2000 0930 5/16/2000 1030 XSI-01056 <br /> M Initial Information Reported Wind Speed/Direction <br /> Approx.2 gallons of gasoline had over flowed from a gasoline pump. Station <br /> Attendant refused to cleanup the spill. <br /> Reporting Party Name Address Telephone No. <br /> Craig Young N/A 209-603-7692 <br /> ir. Responsible Party Name Address Telephone No. <br /> N Grewal's Gas&Liquor 4100 E. Fremont St., 209-463-5294 <br /> Stockton, CA 95215 <br /> Responsible Party Representative Name Address Telephone No. <br /> Amrit Grewal(manager) 4100 E. Fremont St., 209-463-5294 <br /> Stockton. CA 95215 <br /> OES HazMat Team OES Personnel On Scene <br /> Activated <br /> Robert <br /> YES <br /> Joint Team Activated? Date/Time Activated Members On Scene <br /> Q NO <br /> Fire District Mitigation/Removal Actions <br /> 22 City of Stockton Manager/Employee had removed the spill with absorbent prior to the arrival of <br /> Environmental Health and OES inspectors. <br /> Agency Notifications and/or Referrals <br /> Name of Agency Date of Notification Time of Notification Name of Representative <br /> Notified <br /> Co.Environmental Health 5/16/2000 0945 Allison Youngblood <br /> State OES Warning Center 5/17/2000 0945 Randy Schulley <br /> P <br /> Rcporting Officer Signature CHMIR Filed? Incident Type <br /> Q Yes Fixed Facility, Accident <br /> Page 2 <br />