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From:CALIFORHIA STATE WARNINaTR 19168458910 09/0.011 11 :52 #429 P.001/001 <br /> California Emergency Management A�fe d <br /> Hazardous Materials Spill Report <br /> DATE: 09/02/2011 RECEIVED BY: CONTROL#: <br /> TIME: 1138 Cal EMA. Ruben Rodriguez Cal EMA- 11-5232 �� O <br /> OSPR- NRC- <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: Amowu Measure e.TYPE: d.OTHER: e. PIPELINE f. VESSEL <br /> '=` >=300 Tons <br /> 1. Sulfti is Acid = 10 Gal(s) CHEMICAL O Yes •No O Yes • No <br /> 2• = O Yes 0 No O Yes 0 No <br /> 3. = O Yes *No O Yes 0 No <br /> g. DESCRIPTION: A pump was drained,when it was,it was noted that the release ocurred to secondary <br /> containment. <br /> It.CONTAINED: i.WATER j.WATERWAY: IL DRINKING WATER IMPACTED <br /> INVOLVED: <br /> Yes NO <br /> 1.KNOWN IMPACT <br /> J. a.INCIDENT LOCATION: 3028 Navy Drive <br /> It.CITY: c.COUNTY: d.ZIP: <br /> Stockton San Joaquin County 95206 <br /> 4.INCIDENT DESCRIPTION: <br /> a.DATE: It. TIME (Military). c.SITE: d. CAUSE <br /> 09/02/2011 0808 Industrial Plant Human Error <br /> e. IN.IURIES f.RATALITY g.EVACUATION It.CLEANUP BY: <br /> O Yes •No O Yes •No O Yes ♦No Responsible Party <br /> <br /> <br /> <br /> <br /> <br /> 6. NOTIFICATION INFORMATION: <br /> k.ON SCENE: It.OTHER ON SCENE: c.OTHER NOTIFIED: <br /> d.ADMIN.AGENCY: San Joaquin County Emergency Services e.SEC.AGENCY: <br /> I. ADDITIONAL COUNTY: g.ADMIN.AGENCY: <br /> h.NOTIFICATION LIST: <br /> DOG Unit: RWQCB Unit: 5B <br /> ®AP/cUPA ❑Ant;u=uitm sD ❑DPR ❑Cil IMAHAZMA]V F-1 S ❑on'FffiR <br /> ®DMI-OSPR ❑CALIRAHS ❑FHPARKS ❑c.]E PFJ uiirr ❑USMMS ❑DFO/oSPR/MSO <br /> N=c El MF ❑EMSA 11 EMA REO ❑USCG <br /> ®RWQM ❑CoA4 com ❑FEMA ❑OSHA ❑c.K <br /> OMS A 1:1 MPH-D.0 ❑M)OD&AO ❑PARKS&RSC ❑coaffi <br /> ®USFVJS ❑DOO ❑n.NNDS ❑PUc ❑coo-nih <br /> CONTIDENTIAL <br /> REN Ks' <br /> Fi'atning.eenter(oAips.caltma.ca.govI R9 RRC({-TPA.GOV,DTSCF.R�a gmail.cnul <br /> mwaltrin(&waterboardsxs.gov <br />