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11/30/2011 WED 16:45 FAX 2094683433 SJC EHD 0001 <br /> ++++«+xxxxxxrr++xrri+ <br /> ++« FAX TX REPORT r«x <br /> +x++++++«+xxx++rrrxr+ <br /> TRANSMISSION OK <br /> JOB NO. 4461 <br /> DESTINATION ADDRESS 99536268 <br /> PSWD/SUBADDRESS <br /> DESTINATION ID OES <br /> ST. TIME 11/30 16.44 <br /> USAGE T 00' 30 <br /> PGs. 1 <br /> RESULT OK <br /> From:CALIFORHIA STATE WARNING CNTR 19168458910 11/30/2011 16:28 #153 P.001/001 <br /> California Emergency Management Agency <br /> Hazardous Materials Spill Report <br /> DATE: 11130/2011 RECEIVED.BY: CONTROL#: <br /> TIME: 1617 Cal EMA- Timothy Britt Cal EMA- 11-7100 <br /> OSPR- NRC- 996860 <br /> <br /> <br /> <br /> Lb. PERSON REPORTING SPILL(If different front above): <br /> 1. NAME: 2. AGENCY: 3. PHONE#: 4.Ext: S.PAG/CELL: <br /> I <br /> 2. SUBSTANCE TYPE: ' <br /> 2.a.SUBSTANCE: b.QTY: Anrowa Meanve e.TYPE: d.OTHER: e, PIPELINE G VESSEL <br /> '=` >=300 Tons <br /> 1.Ammonium - 375 cal(s) - CHEMICAL O Yes ♦No O Yes ♦ No <br /> Hydroxide 2946 <br /> 2. _ O Yes 0 No O Yes No <br /> 3. = O.Yes 0 No O Yes No <br /> g.DESCRIPTION: RP States that while unloading a truck the storage bails was over tilled. The release was to <br /> concrete secondary contaimnent. No waterways were impacted. <br /> h.CONTAINED: 1.WATER j.WATERWAY: k DRINMNG WATER IMPACTED <br /> INVOLVED: <br /> Yes No <br /> 1.YNOWN 1NIPACT None <br /> 3. n.INCIDENT LOCATION:. 3025 Navy Drive j <br /> b.CITY: c.COUNTY: d.ZIP: <br /> Stockton San Joaquin Cotmty 95206 <br /> 4.INCIDENT DESCRIPTION: <br /> a.DATE: b. TLVIE (Military). c.SITE: d. CAUSE <br /> 11/3012011 1505 Industrial Plant (hertlow <br /> e. INSURIFS f. FATALCIY g.EVACUATION h.CLEANUP BY: <br /> O Yes 0 No O Yes *No O Yes *No, Reporting Party <br /> <br /> <br /> <br /> <br /> i <br /> 6. NOTIFICATION INFORMATION: - <br /> h.ON SCENE: b.OTHER ON SCENE: c OTHER NOTIFIED: <br /> d.ADMIN.AGENCY: San loayuin Conroy Enerxmcy SwNccs e.SEC.AGENCY: <br /> L ADDITIONAL COUNTY: g.ADMIN.AGENCY: i <br /> h.NOTIFICATION LIST: <br />