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From:CALIFORHIA STATE WARNIwNTR 19168458910 05/02 4 <br /> 12 13:28 #073 P.001/001 <br /> California Emergency Management Agency <br /> Hazardous Materials Spill Report <br /> DATE: 05/02/2012 RECEIVED BY: CONTROL#: <br /> TIME: 1321 CaIEMA. RobertMctae CaIENIA- 12-2623 <br /> IOSPR- I NRC- <br /> <br /> <br /> <br /> 1.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: AMonnt Menawe c.TYPE: d.OTHER: e. PIPELINE f. VESSEL <br /> '_" >=300 Tons <br /> 1. Sulfuric Acid = 4 Gal(s) CHEMICAL O Yes 0 No O Yes 0 No <br /> 2. = O Yes 0 No O Yes 0 No <br /> 3. = O Yes 0 No O Yes • No <br /> g.DESCRIPTION: The caller is reporting an injection system developed a leak. <br /> h.CONTAINED: I.WATER j.WATERWAY: k.DRINKING WATER IMPACTED <br /> INVOLVED: <br /> Yes No No <br /> 1.KNOWN IMPACT None <br /> 3. a.INCIDENT LOCATION: 3028 Navy Drive <br /> b.CITY: c.COUNTY: d.ZIP: <br /> Stockton San Joaquin County 95206 <br /> 4.INCIDENT DESCRIPTION: <br /> a.DATE: b. TIME (mwary): c.SITE: d. CAUSE <br /> 04/27/2012 2110 Other Mechanical <br /> e. RMURIFS f.PATALYIN g.EVACUATION h.CLEANUP BY: <br /> O Yes *No O Yes *No O Yes 0 No Responsible Party <br /> <br /> <br /> <br /> <br /> <br /> 6. NOTIFTCATION INFORMATTON: <br /> la.ON SCENE: b.OTHER ON SCENE: c.OTHER NOTIFIED: <br /> d.ADMIN.AGENCY: San,ioaquin County Emergency services e.SEC.AGENCY: <br /> f. ADDITIONAL COUNTY: g.ADMIN.AGENCY: <br /> h.NOTIFICATION LIST: <br /> DOG Unit: RWQCB Unit: 513 <br /> ill AA/CUPA ❑AIR MOURCIZRD ❑DPR ❑Cel FMA HAZN.ATCNrf❑9FM ❑cc/ sib <br /> ®DPO-OVR ❑CALTRANs ❑EBPARICR ❑cetE PI.N uxrr Own ❑OTFn'.R <br /> NMc ❑CpLw ❑R ❑cel aw ❑USMMS ❑DEV/OaPRIMYU <br /> ORWQM ❑CoA4 COM ❑FEMA ❑0. ❑US <br /> NUSVA ❑CDPa-D.O. ❑FOOD&AO ❑PARRa&RRC ❑CONK <br /> ®USt VdS ❑DOG ❑L s ❑PUC ❑CoMffi <br /> CONF'iD -.11L <br /> REMARAS: <br /> Warning.cenfcr!dnpe.calema.ca aor,R9-FtRC�p;EPA.GOV;D1'SC.ER@Wnal1zom <br /> <br /> <br /> <br /> <br />