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From:Cal EMA (State Warning Center) 9168458910 08116/2009 07: ?114 P.001/001 <br /> California Emergency ManagementHazardous Materials Spill RDATE: 08i16,2009 RECEIVED BY: CONTROL#:TIME: 0723 Cal EMA- Danielle Bird Cal EMA- 49-5695j <br /> OSPR- NRC- �! <br /> La. PERSON NOTIFYING Cal EMA: <br /> 1. NAME: 2. AGENCY: 3. PHONE#: 4.Eat: 5.PAGICELL: <br /> Capt.Bill Canfield City of Manteca Fire Dept 209-606-9921 <br /> Lb. 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:a=t Amount Measure G TYPE: d.OTHER: <br /> 1.Freon 500 tbs. VAPOR <br /> 2. - <br /> 3. - <br /> s. Due to mechanical malfunction on a refrigeration unit,Freon was released into the atmosphere. <br /> g , <br /> DEISCRIFTIO.N: <br /> f.CONTAINED: g.WATER INVOLVED: h.WATERWAY: i.DRINKING WATER IMPACTED <br /> Yes No <br /> j.KNOWN <br /> IMPACT <br /> 3. a.INCIDENT LOCATION: Save Mart- 1172 North Main Street <br /> b.CITY: c.COUNTY: d.ZIP: <br /> Manteca San Joaquin County <br /> 4.INCIDENT DESCRIPTION: <br /> a.DATE: b. TIME (Military)-• c.SITE: d. CAUSE <br /> 08/16/2009 0510 Merch.w1uBusiness Mechanical <br /> +` u. !e •E?�VI }?Ill': <br /> i211 ,`ixt f, 1 AT�ki'-18.r. g.EXAC #: k , - <br /> U 0 <br /> 4 None <br /> Same as#1."PERSON NOTIFYING Cal EMA"I <br /> ----------------------------------------------------------------•............ <br /> 5. SUSPECTED RESPONSIBLE PARTY: <br /> a.NAME: b. AGENCY: c.PHONE#: d.EXT.: <br /> Asst Manager Save Mart 209-2239-2267 <br /> Fernando Andrade <br /> e.MAIL f.CITY: g.STATE: h.ZIP: <br /> ADDRESS: <br /> 1172 North Main Street Manteca CA <br /> 6. NOTIFICATION INFORMATION: <br /> k.ON SCENE: b.OTHER ON SCENE: c.OTHER NOTIFIED: <br /> Fire Dept. Cc Health Dept, San Joaquin OES <br /> d.ADMIN.AGENCY: San JOaTLin County e.SEC.AGENCY: <br /> Fanergency Services <br /> f. ADDITIONAL COUNTY: g.ADMIN.AGENCY: <br /> h.NOTIFICATION LIST: <br /> DOG Unit: RWQCB Unit: 58 <br /> ®AAICUPA N USFWS ❑CDPH-D.O. ❑PMMA ❑Cel EMAREG ❑USMMS ❑OTHER <br /> N DFO-OSPR N AiR RESOURCES BD ❑DOC, ❑FOOD&AG ❑OSHA ❑USCo <br /> N DTSC ❑CALTRANS ❑DPH ❑LANDS ❑PARKS&REC ❑co/WP <br /> ®RWQCB ❑CDF ❑EB PARKS ❑Cal EMAHAZMATUNZr❑PUC ❑COMM <br /> N US EPA ❑COASTAL COM ❑EMSA ❑Cal F.MA PLANS UNIT ❑SFM ❑C.S-Mth <br /> i <br />