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Hazardous Materials Spill Res- 12-5806 . Page 1 of 1 <br /> T( cld�u r <br /> �.( Z V� �~� � 1 /1 (tet-',1' r-ra4�L k P <br /> _ ;1_ z Z Ca i rnia Emergency Management Agency 116tot-Q <br /> C11 �t.5� 'Zcer <br /> Ha ardous Materials Spill Report <br /> DATE: 09/27/201 lREECEIVED BY: CONTROL#: <br /> TIME: 080711 Cal EMA- 12-5806 <br /> NRC - <br /> <br /> <br /> <br /> : <br /> 1.NAME: 2.AGENCY: 3. PHONE#: 4. Ext: 5. PAG/CELL: <br /> 2. SUBSTANCE TYPE: <br /> 2.a.SUBSTANCE: b.QTY:>=G9n:aun1 Measure c.TYPE: d.OTHER: e. f. VESSEL <br /> PIPELINE >=300 Tons <br /> 1. Silicone - 200 = 30 Gal(s) CHEMICAL No No <br /> SIL Fluid, Food <br /> Grade Type <br /> 2, = No No <br /> 3. = No No <br /> g. DESCRIPTION:Drum punctured in transit causing the release,material flowed onto the vehicle <br /> trailer and asphalt, on site personnel handled and clean up. <br /> h. CONTAINED: i. WATER j. WATERWAY: k. DRINKING WATER <br /> INVOLVED: IMPACTED <br /> Yes No <br /> 1. KNOWN None <br /> IMPACT <br /> 3. a. INCIDENT LOCATION: 3233 Loomis Rd(USF Redaway) <br /> b. CITY: c. COUNTY: d. ZIP: <br /> Stockton San Joaquin County <br /> 4.INCIDENT DESCRIPTION: <br /> a.DATE: b. TIME (Military): c. SITE: d. CAUSE <br /> 09/27/2012 0800 Merchant/Business Human Error <br /> 1F1 e. INJURIES f. FATALITY g. EVACUATION h. CLEANUP BY: <br /> J No No No on site personnel <br /> 6. NOTIFICATION INFORMATION: <br /> a. ON SCENE: b. OTHER ON SCENE: c. OTHER NOTIFIED: <br /> p San Joaquin Co Env Health <br /> �Zf MM�1Y d.ADMIN. AGENCY: San Joaquin County Emergency Services e. SEC. AGENCY: <br /> =O��lQvl f. ADDITIONAL COUNTY: g.ADMIN. AGENCY: <br /> h. NOTIFICATION LIST: <br /> DOG Unit: RWQCB Unit: 5B <br /> "CUPA,DFG-OSPR,DTSC,RWQCB,US EPA,USFWS <br /> CONEIItMATION <br /> REQUEST: <br /> ********* Control No: 12-5806 ********* <br /> Created by: Warning Center on:09/27/2012 08:07:46 AM Last Modified by: Warning Center on: 09/27/2012 08:12:43 AM <br /> yr-C <br /> htt ://w3.calema.ca. ov/o erational/malhaz.nsf/fl841al03c102734882563e20076Oc4a/23a... 9/27/2012 <br />