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04-17-2002 14:28 From-OES HQ S ENTO W/C 916-845-891 T-630 P.001/001 F-705 <br />..avaL-nmona Vrr14r. yr GIYtG IMUT SkKVIGES <br />2= Hazardous Materials Spill Report <br />DATE: 04/17/2002 RECEIVED BY: CONTROL#: <br />TIME: 1412 OES - Karen Jensen 0 ES - 02-2114 <br />OSPR - NRC - <br />La. PERSON NOTIFYING GO'VERNOR'S OE S: <br />1. NAME: 2. AGENCY: 3. PHONE#: 4. Ext; 5. PAG/CELL: <br />Danny Caltrans/Modesto 209-576-6294 <br />Lb. PERSON REPORTING SPILT, (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;>=< ,4mount Measure c. TYPE: d. OTHER: <br />1. diesel = 75 Gal(s) PETROLEUM <br />2. r <br />3. _ <br />e. DESCRIPTION: Accident caused a semi truck to overturn and rupture the saddletank. <br />f. CONTAINED: g. WATER INVOLVED: h. WATERWAY; <br />Yes No <br />3. a. INCIDENT LOCATION: SB Hwy 99 at Jack Tone Road <br />b. CITY: c. COUNTY: d. ZIP: <br />Ripon San Joaquin County <br />4. INCIDENT DESCRIPTION. <br />a. DATE:04/17/2002 b. TIME (Military): 0445 C. SITE: Road <br />d. INJURIES# e. FATALS #; f. E'VACS #; g. CLEANUP BY: <br />0 1 0 CalTrans <br />M <br />S. SUSPECTED RESPONSIBLE PARTY: <br />a. NAME: b. AGENCY: c. PHONE#: d. EXT.: <br />Unknown <br />e. MAIL ADDRESS; f, CITY: g. STATE: h. ZIP: <br />CA <br />6. NOTIFICATION INFORMATION; <br />�. ON SCENE: b. OTHER ON SCENE: C. OTHER NOTIFIED: <br />d. ADMIN. AGENCY: San Joaquin County Emcrgency Services e, SEC. AGENCY: <br />f. NOTIFICATION LIST.. DOG Unit. <br />RWQCB Unit. 5B <br />AAtCLJPA <br />IX DFGOSPR -T—_ <br />J SMSA <br />OPS PLANS UN11 IT KWQCB - USPWS <br />L..,� AAL "SOURMS RD ❑ DHS.D.O. <br />I <br />v FEMA <br />U 05S REG <br />El SFM ❑ USD01 <br />CALTRANS <br />DOO <br />❑ P000 & AG <br />❑ OSHA <br />E US 12PA 71HER <br />OT <br />�❑ <br />U CPF <br />M❑ <br />�/< OTSC <br />❑LANDS <br />❑ PAW &. REC <br />❑-�� USMMS <br />U COASTAL COM <br />F-1Sa PARKS <br />❑ 049 HAWATUNIT ❑ YUC <br />U USCo <br />