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From:GALIFORHIA STATE WARNING CNTR 19168458910 09/23/2011 12:07 G'# 01 <br /> California Emergency Management Age j <br /> (Hazardous Materials Spill Rep <br /> DATE: 09/23/2011 RECEIVED BY: CONTROL#: ¢ I <br /> TIME: 1158 Cal EMA- Courtland Ellis Cal EMA- 11-5667 <br /> ,OSPR- NRG- <br /> La. PERSON NOTIFYING Cal EMA: <br /> 1. NAME: 2. AGENCY: 3. PHONE#: 4.Ext: 5.PAG/CELL: <br /> Randy May Manteca FD 209-606-9921 <br /> Lb. PERSON REPORTING SPILL(If different from above): i <br /> 1. NAME: 2. AGENCY: 3. PHONE#: 4.Ext: S.PAG/CELL.- <br /> 2. <br /> AG/CELL:2. SUBSTANCE TYPE: 1 <br /> 2.a.SUBSTANCE: b.QTY: Amoruu Measure c.TYPE: d.OTHER; e. PIPELINE f. VESSEL <br /> '=< >=340 Tons <br /> Gal(s) CHEIAICAL p Yes • No O Yes 9 No i <br /> Organophospho <br /> rus <br /> 2. = Q Yes 0 No O Yes • No <br /> 3. _ O Yes ♦No O Yes f No <br /> g.DESC:I IPTIONT. An illegal dtunp caused this release of a pesticide to the asphalt in a parking lot <br /> i <br /> h.CONTAINED: i.WATER j.WATERWAY: k.DRINKING WATER r%1PACTED <br /> INVOLVED: <br /> Yes No No <br /> 1.KNOWN IMPACT bone <br /> 3. a.INCIDENT LOCATION: 1172 North Main <br /> b.CITY: c.COUNTY: d.ZIP: <br /> Manteca. San Joaquin County. 95336 ufyPj <br /> 4.INCIDENT DESCRIPTION: <br /> a.DATE: b. TIME (Military): 0.SITE: d. CAUSE 3 <br /> 09/23/2011 1033 Merchant,13usiness 19unian:Error ! <br /> e. I`;.II'TUIN 1. FATMI'1'FY g. EVACUATION h� CLEANUP BY-, <br /> Q Yes ♦No Q Yes *No 0 Yes •No Contractor <br /> I <br /> 5. SUSPECTED RESPONSIBLE PARTY: <br /> a.NAME: b. AGENCY: c.PHONE#: d.EXT.: <br /> Unknown <br /> 1 <br /> e.MAIL ADDRESS: f. CITY: g.STATE: h.ZIP: <br /> Unknown CA <br /> 6. NOTIFICATION INFORMATION: <br /> Ia.ON SCENE: b.OTHER ON SCENE: c.OTHER NOTIFIED: ! <br /> Fire Dept.,Police Dept. <br /> d.ADMIN.AGENCY: Sam Joaquin County Fancrgency Services e. SEC.AGENCY: <br /> f. ADDITIONAL COUNTY: g.ADMIN.AGENCY: <br /> h.NOTIFICATION LIST: <br /> DOG Unit: RWQCB Unit: 5B <br /> ®AA/CUPA ❑AIR RESOURCES$D ®APR ❑Ca:EMA HAz ATUNIT❑SFM ❑OTHER <br /> IRDFO-OSPR ❑CALTRANS ❑EB PARKS ❑Cal EMAPLANS UPFIT ❑USMMS ❑DFGIOSPR/MSU <br /> ®DTSC ❑CDF ❑EMSA ❑Cal EMAREG ❑USCG <br /> ®RWQCB ❑COASTAL COM ❑FENLA ❑OSHA ❑Cot" <br /> ®US EPA ❑CDPH-D.0 ❑FOOD&AG ❑PARKS&RFC ❑COMM <br /> M USFWS ❑DOG ❑LANDS ❑PUC ❑Co/E-Filth <br /> C'.ON T1DLN'('U!_. + <br /> [ d f <br /> ( , i W,rrair622 <br /> Fciertu;np.N.c_sEtea1u6a.c6R.k}?9orsa;n;t.saennPei/ ratE1rps.r}}.,cra-c.Asnywsi;�vIt;a3jT-nfLoEt+fitk`(rr�if?��:Pr'•A�i.}�.�£ry.ir)a1.Y�;U7�3';!'!S'�L$.r-E,,�fntnl(lrec�.„sp�fEaErlip'-cr,rotm?�rw <br /> 5.gov-,�shalttti:i:�_wxi}fr.ea-#;rev, . <br /> U-ats� - <br />