Laserfiche WebLink
From:Cal EMA (State Warnin nter) 9168458910 13/2009 07:37 4 P.001/001 <br /> 14- <br /> California Emergency Management Ag cy �Z <br /> Hazardous Materials Spill Repo <br /> DATE: 12/03/2009 RECEIVED BY: CONTROL#: <br /> TIME: 0727 Cal EMA- Joe Davey CalEMA- 09-8065 <br /> OSPR - INRC- <br /> <br /> <br /> <br /> <br /> I.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 e.TYPE: d OTHER: <br /> 1.Aqua Ammonia < 50 Gal(s) C IAEMICAL <br /> 2. _ <br /> 3. = <br /> e.DESCRIPTION: Caller states that a gasket failure on pipeline was damaged which caused release onto the <br /> ground. <br /> L CONTAINED: g.WATER It. WATERWAY: i.DRLNHING WATER IMPACTED <br /> INVOLVED: <br /> Yes No No <br /> j.KNOWN IMPACT None <br /> 3. a.INCIDENT LOCATION: 16777 Howland Road <br /> b.CITY: c.COUNTY: d.ZIP: <br /> Lathrop San Joaquin County 95330 <br /> 4.INCIDENT DESCRIPTION: <br /> a.DATE: b. TIME (Miilmy): c.SITE: d. CAUSE <br /> 12/02/2009 2030 Merchant/Business Other <br /> Description for Other: Gasket <br /> Failure <br /> e. _I3N.JI1RiES# f.FAT:I LS#: g. E}'ACS it. h.CLEANTJP BY: <br /> 0 0 0 Reporting Party <br /> <br /> <br /> <br /> <br /> <br /> 6. NOTIFICATION INFORMATION: <br /> �a.ON SCENE: b.OTHER ON SCENE: c.OTHER NOTIFIED: <br /> Env Health <br /> d.ADMIN.AGENCY: Sm Joaquin County e.SEC.AGENCY: <br /> Fine�enty Sm•itts <br /> E ADDITIONAL COUNTY: g.ADMIN.AGENCY: <br /> h.NOTIFICATION LIST: <br /> p1 <br /> DOG Unit: RWQCBUaW 5B <br /> N AA/CDPA U 3 ❑CDM-D o. ❑FEMA ❑C.I EMARED ❑umaw ❑OniEEP. <br /> Z DFO-OSPR ❑AB =OU =BD ❑D00 ❑FOOD A AO '❑09 ❑=0 <br /> ®DISC ❑CAL'r s ❑DPR ❑LAlaJa ❑PAlUCB RREC ❑C./ p <br /> ORWQCB 13=F ❑EBPARICa ❑GIEMAHAEMA El PUC ❑Co/H <br /> N M EPA ❑COASTA coo ❑EMA ❑Cel EMAPLAm VNR ❑sra ❑C.7,Mth <br /> lvarning.cenrer@ws.ca.gov;RS RRC;rzEPAGOV;DTSC.ER•fgmaJ1xom <br />