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05-17-2008 05:25pm From-OES HO SACRAMENTO W/C 916-845-8910 T-274 P.001/001 F-050 <br /> U i� GOVERNOR'S t_ ICE OF EMERGENCY <br /> PYSERVICES <br /> '..�..m,.w,. Hazardous Materials Spilla ort <br /> DATE: 05/17/2008 RECEIVED BY: CONTROLM d <br /> TIME: 1625 OES- Davin Godwin OES. 08-3575 <br /> OSPR- NRC <br /> l.a. PERSON NOTIFYING GOVERNOR'S OES; <br /> Mn <br /> 1. NAE: 2. AGENCY: 3. PHONE#: 4.Ext: 5.PAG/CELL: /�.J <br /> Cynthia Barber HJ Hines 209-649-2978 v <br /> l.b. PERSON REPORTING SPILL(If different from 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 c.TYPE. d.OTHER: <br /> 1.Waste Water = Unknown Unknown OTHER Processed <br /> Water <br /> 2. <br /> 3. = <br /> e.DESCRIPTION: Caller states substance was released when a wall failed. Caller states that due to the failure <br /> substance was allowed to enter a storm drain Caller states it's unknown if released substance has made it into the eiry <br /> storm drain system from the plant system <br /> f.CONTAINED: g.WATER INVOLVED: h.WATERWAY: i.DRINKING WATER IMPACTED <br /> Yes Yes Storm Drain No <br /> 3. a.INCIDENT LOCATION: 2800 South Calif St <br /> b.CITY: c.COUNTY: d.ZIP: <br /> Stockton San Joaquin County <br /> 4.INCIDENT DESCRIPTION: <br /> a.DATE:05/16/2008 b. TIME (Military):1100 C.SITE: Industrial Plant <br /> d. INJURIES# e.FATALS#: f.EVACS#: g.CLEANUP BY: <br /> 0 0 0 Contractor <br /> Same as#1."PERSON NOTIFYING OPS" <br /> S. SUSPECTED RESPONSIBLE PARTY: <br /> a.NAME: b. AGENCY: - c.PHONE#: d.EXT.: <br /> Cynthia Barber HJ Hines 209-649-2978 <br /> e.MAIL ADDRESS: f.CITY: g.STATE: h.ZIP: <br /> PO Box 57 Stockton CA 95201-3057 <br /> 6. NOTIFICATION INFORMATION: <br /> Ia.ON SCENE: b.OTHER ON SCENE: e.OTHER NOTIFIED: <br /> Other City of Stockton Waste/Storm Water Co OES,Env Health,Sberitf7Firo Dispate <br /> City of Stockton Storm/Waste Water Dept <br /> d.ADMIN.AGENCY: San Joaquin County Hmcrgcncy Services e.SEC.AGENCY: <br /> f.NOTIFICATION LIST: DOG Unit. RWQCB Unit: 5B <br /> 1 Lrr:',7 AA(CUPA Z USFWS ❑oH�•n 0. ❑FWD&AG I❑OSHA Q uSG <br /> C <br /> {L J DFG-OSPK ❑AI R ROSOUACES BD l r 1 DOG C-1 LANDS LA1 PARKS&AEC ❑II USDOI <br /> LnJ OTSc ❑CALTRANS �(. BE PARKS ❑OhS HAZMATUNIT El PEJO �J OTHER <br /> u <br /> � kwQcU ILLI CDL' L EMSA ❑0C1 YLAm umi ❑J2'M <br /> l'�Us}.PA L:•>�COASTAL COM ❑FSMA ❑OBS KfiG ❑IISMMS <br />