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Cal ESR (State Warning Gr-,` '.gsr) 9168458910 0612X009 Q .0011002 <br /> Z D <br /> California Emergency Manage c <br />!, Hazardous Materla[s S X O <br /> DATE: 06122/2009 RECEIVED BY: CONTROL#: -'` j: I <br /> TIME: 1938 Cat EMA- Kavin GodwinCal MAA- 494535 <br /> OSPR- JNRC • <br /> 1.s. PERSON NOTIFYING Cal EMA: <br /> 1.'NAME: 2. AGENCY: 3. PHONE#: 4.EstS.PAWCELL: <br /> Robert San Joaquin OES 209-815-2985 <br /> Lopez <br /> 1.b. PERSON REPORTING SPILL(if different from above): <br /> 1. NAME: 2. AGENCY: 3. PHONE#: 4.Ext: .5.PAG/CELL- <br /> 2. SUBSTANCE TWE.- <br /> 2. <br /> YPE:2.a.SUBSTANCE: b.QTY:y=•c Amoral Measure G TYPE: d.OCHER: <br /> 1.Drug Lab Wastc - 560 GOS) C M TICAL <br /> 2. - <br /> 3, - <br /> C. Caller states eleven 55 gallon drums of coritwumted sail and dnag waste was recovered from a <br /> DESCRIPTION: mcdz dump along with a five gallon ccastainer of a sodium hydroxide solution. <br /> f CONTAINED: g.WATER INVOLVED: h.WATERWAY: i.DRDMING WATER IMPACTED <br /> Yes 1�a <br /> J.KNOWN None <br /> IMPACT <br /> 3. a.INCIDENT LOCATION: 475 Belwctt Rd <br /> b.CITY: c..COUNTY: d.ZIP: <br /> Unincorporated Sart Joaquin County 95385 <br /> count}area <br /> 4.INC)DENT DESCRIPTION: <br /> a.DATE: b. TOM Mhawyk C.SITE: d. CAUSE <br /> 06712212009 0915 Other Other <br /> Description for Other:Man Made <br /> e. IN.IURIF.S# i*FATALS#: g. FVACS#: h. CLEAT'IT DY: <br /> 0 0 0 DISC <br /> .'-Same as#1 PE nSON NOTIFYING:Cel EMIR" <br /> `............. I..."...... .....................—........................... <br /> S. SUSPECTED RESPONSIBLE PARTY: <br /> a.NAME: b. AGENCY: c.PHONE#: d.EXT.: <br /> Unhnavvra . <br /> e.MAIL r.CITY: g.STATE: h.ZIP: <br />' ADDRESS: <br /> CA <br /> 6. NOTIFICATION INFORMATION: <br /> (a.ON SCENE: b.OTHER ON SCENE: c.OTHER NOTIFIED: <br /> Co Health,Co OES.Sheriff'O€c. <br /> d.ADAUN.AGENCY: e.SEC.AGENCY: <br /> f. ADDITIONAL COUNTY: g.ADMIN AGENCY: <br /> h.NOTIFICATION IMT: <br />' DOC Usk- RWQCS UUM SA <br /> AMct7PA COMM MM-no: PM" ❑ZWsMAarss ❑ ❑ <br /> 0DFO.01R ❑ATILMOURCES M ❑bOG ❑FOOD&A:i ❑OSHA ❑USCG <br /> I �DRSC ❑CALTRAN9 DMR ❑LAUDS ❑PARSS SRSC ❑c no <br /> ®�pp RWQC9 ❑CDF ❑FB PA= ❑GW EWAHAZdA'CUHIT❑PUC ❑C-006 <br /> OUSEPA ❑COASrALCOM ❑DaA' ❑0a1Ea(AFT"Buier ❑VU ❑c-s4 tly <br />