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12-05-2003 08:48 From-OES NQ SACr-'ENTO W/C <br /> 816-845-8910 i-521 P.001/002 F-463 <br /> Jy �* �uvcrcrvvtt s Ut-MUE OF EL�tGENCY SERVICES <br /> 7Er=n� Hazardous Materials Spill Report <br /> DATE: 12/04/2003 <br /> TIME: 1057 RECEIVED BY: <br /> OES• Toni Walthour CONTROL#: <br /> OSPR- OES- 03-6252 <br /> i.a. PERSON NOTIFYING GOVERNOR'S OES: NRC. 707077 <br /> :j <br /> I. NAME. 2. AGENCY: <br /> George Odell Chevron Pipeline 3. PHONE#. 4. Ext. 5.PAG/CELL: <br /> p 281-596-2173 713- <br /> 1-b. PERSON REPORTING SPILL(If different 11•om above): 515-3321 <br /> I. NAME: 2. AGENCY; 3. PHONE#: 4. Ext: <br /> 5. PAC/CELL: <br /> 2. SUBSTANCE TYPE: <br /> Z.a.SUBSTANCE; b.QTy;n-< gnmunr Measure <br /> 1. crude oil = e.TYPE: d.OTHER: <br /> IJN1C NIA <br /> 2. PETROLEUM <br /> _ <br /> 3. - <br /> e.DESCRIPTION: A fanner hit it pipeline causing a leak. They are enroute to investigat . ta' the <br /> Feld. <br /> L CONTAINED; g.WATER INVOLVED: h.WATERWAY; i.DRINKING WATER IMPAC D <br /> Yes No <br /> 3. a.INCIDENT LOCATION: Patterson Pass Road and Route 205 <br /> b. CITY: e.COUNTY: d.ZIP: <br /> Tracy San Joaquin County <br /> 4.INCIDENT DESCRIPTION: <br /> a.DATE:12/042003 b. TIME (Military):0945 C.SITE: Other <br /> d. INJURIES# a.FATALS#: f.EVACS M g.CLEANUP BY: <br /> 0 0 0 Reporting Party and contractor <br /> Same;as#t FPERS0trN0TIFYING.2e ll <br /> 5. SUSPECTED RESPONSIBLE PARTY: <br /> a.NAME: It. AGENCY: c.PHONE#: d. EXT.: <br /> N/A <br /> e.MAIL ADDRESS: f.CITY: g. STATE: It.ZIP: <br /> CA <br /> I6_. NOTIFICATION INFORMATION: <br /> N'.ON SCENE: b.OTHER ON SCENE; c.OTHER NOTIFIED: <br /> Fire Dept. <br /> d.ADMIN.AGENCY: San)ouquin County Emer-4cncy Sotvices e.SEC.AGENCY: <br /> f.NOTIFICATION LIST: DOG Unit. 6 RWQC8 Unit. 5e <br /> 7A.v A C'J DPO.OSpR L1F,.,sA <br /> OES ptAN$UNIT <br /> U AIR RESOURC:?$:a5❑ON&D.O. ❑FEMA a OES NEC �'.l SPM ❑u5O01 <br /> ❑CALTRANs ©DUG ❑FOOD K AO ❑osm ❑US EPA F,OrNER <br /> ❑CDP 11❑�DTSc I�LANDS ❑NARKS&me ElU!fl"5 <br /> LlCOASTAL CDM u EE pN s U DES U ATUNrr ❑PUL ❑USCG - <br />