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From:Cal EMA (State Warning Center) 9168458910 08/03/2009 12:02 4352 P.001/001 <br /> California Emergency Management Agency <br /> Hazardous Materials Spill R <br /> DATE. 08;0312009 RECEIVED BY: CONTROL#: <br /> TIME: 1142 Cal EMA- Danielle Bird Cal EMA- 09-5417 Q�' <br /> OSPR- NRC- <br /> I.a. PERSON NOTIFYING Cal EMA: <br /> 1. NAME: 2. AGENCY: 3. PHONE#: 4.Ext: 5.PAG/CELL: <br /> Michael Holder Ca Army National Guard 916-3694338 <br /> 1.b. PERSON REPORTING SPILL(If different from above): "Dt <br /> 1. NAME: 2. AGENCY: 3. PHONE#: 4. Ext: 5. / L: ' <br /> r <br /> 2. SUBSTANCE TYPE: <br /> 2.a.SUBSTANCE: b.QTY:>=< Amount Measure c.TYPE: d.OTHER: <br /> 1.Diesel(JPA) = 20-30 Gal(s) PETROLEULf <br /> 2. _ <br /> 3. <br /> C. Due to a leak in a fuel line of a company vehicle,diesel was released to the ground. <br /> DESCRIPTION: <br /> E CONTAINED: g.WATER INVOLVED: h.WATERWAY: LDRINICING WATER LM- PACTED <br /> Yes No <br /> j.KNOWN None <br /> IMPACT <br /> 3. a.INCIDENT LOCATION: 333 N Washington Street <br /> b.CITY: c.COUNTY: d.ZIP: <br /> :Lodi San Joaquin County 95240 <br /> 4.INCIDENT DESCRIPTION: .� <br /> a.DATE: b. TIME (Military): c.SITE: d. CAUSE <br /> 08/02/2009 1300 Military Base Mechanical <br /> c. 3URIN S4 f. F h°l A:1_S#: g.EVAC:S#: h.t;I'l ?MJP By; <br /> 0 0 0 Contractor <br /> Same as#1."PERSON NOTIFYING Cal EMA" <br /> -------------------------------...-----..------............--._....._.....I <br /> 5. SUSPECTED RESPONSIBLE PARTY: <br /> a.NAME: b. AGENCY: c.PHONE#: d.EXT.: <br /> Michael Helder Ca Army National Guard 916-369-4338 <br /> e.MAIL f.CITY: g.STATE: h.ZIP: <br /> ADDRESS: <br /> i <br /> Military Dept; 10620 Mather Blvd Mather CA 95655 <br /> i <br /> 6. NOTIFICATION INFORMATION: <br /> la.ON SCENE: b.OTHER ON SCENE: c.OTHER NOTIFIED: <br /> d.ADMIN.AGENCY: San Joaquin e.SEC.AGENCY: <br /> County Emergency Services <br /> f. ADDITIONAL COUNTY: g.ADMIN.AGENCY: <br /> h.NOTIFICATION LIST: <br /> DOG Unit: RWQCB Unit: 5B <br /> ®AWCUPA ®USFWS ❑CDPH-D.O. ❑FEMA ❑Cat EMA REO ❑unom DO= <br /> ®DFO-OSPR ❑AQt RESOURCES BD ❑DOG ❑FOOD&A4 ❑OSHA ❑USCO <br /> u me ❑CALTRANS ❑DPR ❑LANDS ❑PARKS&REC ❑C.AVP <br /> ®RWQCB ❑CDF ❑EB PARKS ❑Cal EMAHAZM T=❑PUC ❑CaMh <br /> IR US EPA ❑COASTAL COM ❑EMSA ❑Cal EMAPLANS UNIT ❑SFM ❑Ca&Hlth <br />