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From:Cai ENIA 'State Warning Center' 9168458910 08/03/2009 -12:02 #352 1'.001/001 <br /> California Emergency Management agency <br /> Hazardous Materials Spill R <br /> 1 <br /> DATE: 08/03;2009 RECEIVED BY: CONTROL#: i t <br /> TEWE: 11,42 Cal EN/1A- Danielle Bird Cal E1\AA- 09-5417 i �Z <br /> `3 � <br /> OSPR - NRC- <br /> 1.a. PERSON NOTIFYING Cal EXIA: <br /> 1. NAME: 2. AGENCY: 3. PHONE#: 4. Est: 5.PAG/CELL: <br /> Michael Holder Ca Army National Chiard 916-369-4335 <br /> Lb. PERSON REPORTING SPILL(If different from above): �:�" r-.,- � <br /> 1. NAME: 2. AGENCY: 3. PHONE#: 4.Ext: 5. / AkL: �`' <br /> 2. SUBSTANCE TYPE: <br /> 2.a.SUBSTAIiCE: b.QTY:>=< Arworw Yleusu�e �.TYPE: d.OTHER: <br /> 11.Diesel(.TPA) = 20-30 Galls) PETR0LEL'_1.1 <br /> 2. _ <br /> 3. _ <br /> t-. Due to a leak in a fuel line of a company vehicle,diesel Was released to the ground. <br /> DESCRIT'M i s <br /> 1f CONTAINED: g.WATER INVOLVED: h.WATERWAY: i.DRINKING WATER E'✓IPACTED <br /> yes No <br /> j.KNOWN :None <br /> IMPACT <br /> 3. a.INCIDENT LOCATION: 333 N Washington Street <br /> b.CITY: c.COUNTY: d.ZIP: <br /> Lodi San Joaquin County 95240 <br /> 4.INCIDENT DESCRIPTION: <br /> a.DATE: b. TIME (Military): C.SITE: d. CAUSE <br /> 08/02/2009 1300 Nfilitary Base Mechanical <br /> t. V%011RIEI� f- FA,TA1, #: g.EVACS r: h, (_A_,E:.A_ 13P BY <br /> 0 0 0 Contractor <br /> Same as#1."PERSON NOTIFYING Cal EMA"i <br /> --------------------------------.....----- ------ --------------------- <br /> 5. <br /> ---------------- <br /> 5. SUSPECTED RESPONSIBLE PARTY: <br /> a.NAME: b. AGENCY: r.PHOIINE4: d. EXT.: <br /> IMichael Holder Ca Army National Guard 916-369-4335 <br /> v.IN AIL f CITY: g.STATE: h.ZIP: <br /> ADDRESS: <br /> Military Dept-, 106201\Aather Blvd Mather CA ?56_55 <br /> 6. NOTIFICATION INFORMATION: <br /> �.ON SCENE: b.OTHER ON SCENE: c.OTHER NOTIFIED: <br /> d.ADMIN.AGENCY: San Joaquin e.SEC.AGENCY: <br /> County Emergency Services <br /> f. ADDITIONAL COUNTY: g.ADNMN.AGENCY: <br /> h.NOTIFICATION LIST: <br /> DOG Unit: RWQCB Unit: 5B <br /> ®AA/CUPA Z USF WS ❑CDPH-D O ❑FEMA ❑Cal EMA REG ❑US11r­1S ❑OTHER <br /> ®DFG-OSPR ❑AIR RESOURCES BD ❑DOG ❑FOOD&AG ❑OSHA ❑USCG <br /> ®DTSC ❑CALTRANS ❑DPP. ❑LANDS ❑PARKS&REC ❑COMM <br /> ®RWQCB ❑CDF ❑EB PARKS ❑Cal EMA HFA MATUNIT❑PUC ❑Co/Hlth <br /> ®US EPA ❑COASTAL COM ❑EMSA ❑Cal EMA PLANS UNIT ❑SFM ❑Cor-Hlth <br />