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Hazardous Materials Spill Report Page 1 of 1 <br /> , � GOVERNOR'S OFFICE OF EMERGENCY SERVICES <br /> A"g h ", Hazardous Materials Spill Report <br /> DATE: 10/24/2005 RECEIVED BY: CONTROL#: <br /> TIME: 0814 OES-05-6144 <br /> NRC - <br /> La. PERSON NOTIFYING GOVERNOR'S OES: <br /> 1. NAME: 2. AGENCY: 3. PHONE#: 4. Ext: 5. PAG/CELL: <br /> BP West Coast Products <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 c.TYPE: d. OTHER: <br /> 1. Gasoline Additive = 1,000-1,500 Gal(s) PETROLEUM <br /> 2. <br /> 3. <br /> e. DESCRIPTION: Substance was released due to a gage breaking. Substance released to a storage <br /> vault (Secondary Containment area). Vacuum truck is enroute. Note: incident location is a gasoline <br /> loading facility. <br /> f. g. WATER h. WATERWAY: i. DRINKING WATER <br /> CONTAINED: INVOLVED: IMPACTED <br /> Yes No <br /> 3. a. INCIDENT LOCATION: 2700 West Washington St <br /> b. CITY: c. COUNTY: d. ZIP: <br /> Stockton San Joaquin County 95203 <br /> 4. INCIDENT DESCRIPTION: <br /> a. DATE: 10/24/2005 b. TIME (Military): 0400 c. SITE: Other <br /> d. INJURIES# e. FATALS #: f. EVACS #: g. CLEANUP BY: <br /> 0 0 0-Contractor <br /> 6. NOTIFICATION INFORMATION: <br /> lIl, ON SCENE: b. OTHER ON SCENE: c. OTHER NOTIFIED: <br /> d. ADMIN. AGENCY: San Joaquin County Emergency e. SEC. AGENCY: <br /> Services <br /> f. NOTIFICATION DOG Unit: RWQCB Unit: 5B <br /> LIST: <br /> AA/CUPA,DFG-OSPR,DTSC,RWQCB,US EPA,USF WS,SPM <br /> ********* Control No: 05-6144 ********* <br /> Created by: Warning Center on: 10/24/2005 08:14:27 AM Last Modified by: Warning Center on: 10/24/2005 08:21:17 AM <br /> http://rimsinland.oes.ca.gov/operational/malhaz.nsf/fl 841 al 03c 102734882563e200760c4... 11/16/2005 <br />