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{ From:GALIFORHIA STATE WARNING CNTR 19168458910 04/2312012 16:40 P.0011002 <br /> d <br /> Ca#ifomia Emergency Management c <br /> Hazardous Materials S lil R o <br /> DATE. 04/23/2012 RECEIVED BY: CONTROL#: <br /> TIME: 1626 Cal BMA- Charles Bickinella Cal EMA- 12-2423 <br /> OSPR- NRC- <br /> 1j. PERSON N07TF NG Cal EMA. <br /> 1. NAME: 2. AGENCY: 3. PHONE#: 4.Ext: 5.PAG/CELL: <br /> Roger Hoffdahal Corn Pi oducts 209-547-8233 <br /> Lb. PERSON REPORTING S ML(If different from above): <br /> 1. NAME: 2. AGENCY: 3. PHONE#.- 4.Ext: S.PAGICELL: <br /> 2. SUBSTANCE TYPE: <br /> 2.&SUBSTANCE: b.QTY: Anoint Memwv r-TYPE: d OTHER: e. PIPELINE f. VESSEL <br /> >=304 Tons <br /> 1.Calcium 750 Gals) CI EhUCAL O Yes*No d Yes 0 No <br /> Hydroxide-CaOH <br /> 2• - --- - O Yes f Nio,q Yes.0 No <br /> 3. O Yes •No Q Yes • No <br /> g.DESCRIPTION: A level control on a 60000 gallon tank failed,along with a possibble leak in a hose.Most of <br /> the release wean into c antammmxt,but the spray from the Ieaking hose went onto a cane <br /> paved area.Cleanup is underway.CaOH is used to adjust the PH of industrial waste water. <br /> IL CONTAINED: L WATER J.WATERWAY: k.DRINIUNG WATER IMPACTED <br /> INVOLVED: <br /> Yes No No <br /> L KNOWN IMPACT None <br /> 3. a.INCIDENT LOCATION: 1021 Industrial Drive <br /> IL CITY: e.COUNTY: d.ZIP: <br /> Stockton .. an Lo° T1!2 County 95206 -- - - <br /> 4.INCIDENT DESCRIPTION- <br /> a.DATE: b. TIME (Aafty) c.SITE: d. CAUSE <br /> 0412312012 1430 Industrial Plant Mechanical <br /> e. RgJURIES L FATALITY g. EVACUATION h.CLEANUP BY: <br /> Q Yes *No 0 Yes i No Q Yes *No Reporting Party <br /> 5. SUSPECTED RESPONSIBLE PARTY: <br /> a.NAME: b. AGENCY: c.PHONE#: d.EXT.: <br /> Roger Hoffdahal Com Products 209-547-8233 <br /> e.MAIL ADDRESS: L CTFY: g.STATE: h.ZIP: <br /> PO Box 6129 Stockton CA 95206 <br /> 6. NOTIFICATION INFORMATION: <br /> �.ON SCENE: b.OTHER ON SCENE: c.OTHER NOTIFIED: <br /> Fire Dept. County CUPA,City of Stockton <br /> Waste Water <br /> d.ADMIN.AGENCY: sin Joaquin county Smagascy savices e.SEC.AGENCY: <br /> E ADDITIONAL COUNTY: g.ADMIN.AGENCY: <br /> h.NOTIFICATION LIST: <br /> DOG Via: RWQCB Unit: 5$ <br /> ®AMCUPA ❑AMRSIDOi==eD ❑DPR ❑0M ZWAJ{ArdiA9MRT❑etc ®cor,m <br /> ®Din-om ❑CAL'aWa ❑M PARn ❑U MAPUM VM! ❑UCSS ❑0nm <br /> HDIW ❑CAUME []EWA ❑Cd EHAR&3 ❑man ❑DFG"WRAZU _ <br /> ®tewQGa ❑COMM.COM ❑FE WA ❑ORFA ❑us= <br /> ®U6 RpA ❑CW D.O. ❑FOOD&AO ❑PAREE AREC ❑o~ <br /> ®UMM ❑D0a ❑arcs ❑PUC Wean <br /> CONFUMNITIAL <br /> REMARKS: <br /> Wwnt i c ps catem*.c&4pr,R4_RRi:(gKPA.COV,DTSC.ER n*9.com <br /> f <br />