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From.`Cal EMA (State Warning Cefr) 9168458910 09/23410 17:56 #51 Z- 0001/001 <br />C�J//ll h . <br />California Emergency Management i <br />Hazardous Materials Solll Re <br />DATE: 09/23/2090 <br />RECEIVED BY: <br />CONTROL#: " <br />TME: 1746 <br />Cal EMA- Blake Tyson <br />Cal EMA - 10-5728 } <br />Yes No <br />OSPR - <br />NRC - <br /> <br /> <br /> <br />I.b. PERSON REPORTING SPILL (If different from above): <br />L NAME: 2. AGENCY: 3. PHONE#: 4. Ext: S. PAG/CELL: <br />2. SUBSTANCE TYPE: <br />2. a. SUBSTANCE: b.QTY:a=c Armomu Menses c. TYPE: d. OTHER: <br />I. Acid - Sulfuric - 2 oz. CHENfICAL <br />2. _ <br />'3. _ <br />e. DE SCRIF1 IOIN: Valve dripping caused release onto soil. Leak contained and repairs are ordered. <br />f. CONTAINED: g. WATER <br />h. WATERWAY: <br />i.DRIlQaNG WATER UKPACTED <br />EWOLVED: <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />P- MAM ADDRESS: f CITY: <br />g. STATE: <br />h. ZIP: <br />16777 Howland Rd Lathrop <br />CA <br />95330 <br />6. NOTIFICATION INFORMATION: <br />la. ON SCENE: b. OTHER ON SCENE: <br />c. OTHER <br />NOTIFIED: <br />San Joaquin County WP <br />d. ADMIN. AGENCY: San Joaquin e. SEC. AGENCY: <br />County Fine pmq Services <br />f. ADDITIONAL COUNTY: g. ADM1N. AGENCY: <br />h. NOTIFICATION LIST: <br />DOG Unit: RWQCB Unit: 5B <br />®AAJCUPA o umn ❑ CDPH-D.O. ❑ FEMA <br />❑ Cal EMA Rm <br />❑ Um us ❑ 04'}4.R <br />®DMOSPR ❑ AM RESOURCES BD ❑ DOC! ❑ FOOD & AO <br />❑ OSHA <br />❑ USCO <br />® DTSC ❑ CALTRANS ❑ DPR ❑ 1A <br />❑ PARKS a RSC <br />❑ C.AW <br />® RWQCB ❑ CDF ❑ EB PARKS ❑ ed EMA HAnLcuNz <br />❑ PUC <br />❑ C,4ft <br />® US EPA ❑ COASTAL COM ❑ EMSA ❑ CA EMA PARKS U)M <br />❑ SFM <br />❑ C.T Mh <br />CONFIDENTIAL <br />RENURKS <br />R'arning.center@w.&ca-gov; R9_RRC ,F,PA.GU'V. DTSC kMftrnn9.com <br />