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Road Dist. 5 HAZARDOUS MATERIALS Case x 87-7466 <br /> Fire Dist. 2 NOTIFICATION FORM Class " — <br /> Level <br /> A. Date: 3-26-87 Present Time: 2350 Incident Time: 2326 <br /> B. Reported by: Elmer Loy Home Telephone: 237-3732 <br /> C. Home Address: <br /> Street name & Number City Zip <br /> D. Calling From: / Telephone: <br /> Address City <br /> E. Type of Incident: [ ] Explosion [ ] Spill [ ] Leak [x ] Crash [ ] Fire <br /> [ ] Irritant [ ] Abandon/dumped [ ] Other: <br /> F. What Happened: Truck crash spilling gas <br /> G. Number of Injuries: yes By Material: No Type: <br /> EXACT LOCATION Address: Jack Tone & Hwy 120 <br /> H. Name of Business: <br /> I. Type of Structure: <br /> J. VEHICLE(s) ; I .D.*: Lic.*: State: <br /> K. Environment Affected: YJ Soil : [X] Road: <br /> [ ] Water: [ ] Air: <br /> L. Population: ( ] None [ ] Urban p{ ] Rural [ ] Business [ ] Industrial <br /> M. Weather: Wind 10 mph From W ° Temp 57 ° Humidity 36 % Other <br /> N. Evacuation/Shelter Action: Limited to 1500 feet When: 1200 <br /> Shelter at Calla Hi School , Larry Musial, Principal opened up <br /> IDENTIFICATION OF MATERIAL 10 homes, 1 family showed up <br /> 0. Substance Form: [ ] Solid [ ] Powder [ ] Gas [X] Liquid [ ] Granule <br /> P. Type of Container: Tank truck Condition: Fair <br /> Q. Quantity of Material: 3, 500 gallons <br /> R. Trade Name: Gasoline Chemical Name: <br /> S. UN & EPA Number: 1203 Hazard Class: Flammable Liquid <br /> T. Placard Description: Red Placard No. : 3 <br /> U. Manufacturer's Name: Williams Tank Lines Telephone: (20!� 944-5683 <br /> 2941 avy rive <br /> V. Shipper's Name: Telephone: ( ) <br /> W. Carrier's Name: Williams Tank Lines Telephone: ( ) <br /> X. Consignee Name: Telephone: ( ) <br />