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From:Cal EMA (State Warning Co^ter) 9168458910 04/0R/2011 14:54 # 4 P.001/002 <br /> California Emergency Management Age y 4 <br /> Hazardous Materials Spill Re <br /> DATE: 04/08/2011 RECEIVED BY: CONTROL#: O <br /> TIME: 1435 Cal EMA- Bob Mcrae Cal EMA- 11-2251 O <br /> OSPR- NRC- <br /> La. PERSON NOTIFYING Cal EMA: <br /> 1. NAME: 2. AGENCY: 3. PHONE#: 4.Ext: 5.PAG/CELL: <br /> .Ron Penix City of Lodi 209-329-5066 <br /> Lb. 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 e.TYPE: d.OTHER: e. VESSEL <br /> '=` >=300 Tons <br /> 1.Diesel - UNK Unknown PETROLEUM O Yes 0 No <br /> 2. = O Yes ♦ No <br /> 3. = O Yes ♦ No <br /> e.DESCRIP'.I'I0N: A big nig was in involved in a traffic accident and damaged fuel tank,. The truck ended up on <br /> railroad right-a-way. The spill has been cleaned up. <br /> f. CONTAINED: g.WATER h.WATERWAY: i.DRINKING NVATER IMPACTED <br /> INVOLVED: <br /> Yes No No <br /> j.KNOWN IMPACT None <br /> 3. a.INCIDENT LOCATION: Guild at Lodi.Ave <br /> b.CITY: c. COUNTY: d.ZIP: <br /> Lodi San Joaquin County <br /> 4.INCIDENT DESCRIPTION: <br /> a.DATE: b. TIME (Military): c.SITE: d. CAUSE <br /> 04/07/2011 0137 Other Collision <br /> I% INJURIES f.FA TA.L,ITY ,.:l;V ACLIATIO.N h.CLEANUP RY: <br /> O Yes *No O Yes 0 No O Yes 0 No Contractor <br /> 5. SUSPECTED RESPONSIBLE PARTY: <br /> a.NAME: b. AGENCY: c.PHONE#: d.EXT.: <br /> e.MAIL ADDRESS: f.CITY: g.STATE: h.ZIP: <br /> CA <br /> 6. NOTIFICATION INFORMATION: <br /> Ia.ON SCENE: b. OTHER ON SCENE: c. OTHER NOTIFIED: <br /> Police Dept. Co. OES,Co.Env Health <br /> d.ADMIN.AGENCY: San Joaquin County Emergency Services e.SEC.AGENCY: <br /> f. ADDITIONAL COUNTY: g.ADMIN.AGENCY: <br /> h.NOTIFICATION LIST: <br /> DOG Unit: RWQCB Unit: 5B <br /> ®AA/CUPA ❑AIR RESOURCES BD ❑DPR ❑Cal EMA HAZMATUNIT❑sFM ❑OTHER <br /> ®DFG-OSPR ❑CALIRANS ❑EB PARKS ❑Cal EMAPLANS UNIT ❑USWa ❑DFG/OSPRMISU <br /> N DISC ❑CDF ❑EMSA ❑Cal EMA REG ❑USCO <br /> N RWQCB ❑COASTAL COM ❑FEMA ❑OSHA ❑CO/WP <br /> ®US EPA ❑CDPH-D.O. ❑FOOD&AG ❑PARKS&REC ❑CO/Hlth <br /> ®USFWS ❑DOG ❑LANDS N PUC ❑Co/E-Hlth <br /> CONFIDENTIAL, <br /> REMARKS: <br /> l�'>Zrn1n&.Ct:I1tP.rL�r��f5.cfi3e:Rla.CR r0�';E:•i.3!cpucxa.gov;C 3(4:.c ue.cR goo;R.Q RRC,@F.FA.GOV;dri4LrL.cpuC..cI,g0v;edc(�puc.ca.gov; <br /> DTSC.ER4tgmaiE. -III;erS@cpucxa.gov:ernie.sirotek/n:.dtA.gtc;gc-gt&puc.:'a.gov:ggLari.-uC.ca Vov;EljV., PU:.cR.,V,ov; <br /> 1h2;�ctnu.cR.i?av;jh�Gj,C.ilili'.cA.kov;1pf�a7,c.-i�ur,.ca.gov;jrc.far)ryrr2cpuc.ra.got;.uigrl r:v.ptc.cA.gov;;ViFi3:'�a7,-c:i�rlc.ca.gov: <br /> nlithael.fan�e�adriLgoy;rns3;;i;:cpu:.ca coy;rnC![Fi,CpUC,r_R.g06';Slt(arLFFc.C:i boy <br />