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Hazardous Materials Spill Re 13-6583 4 Page 1 of 1 <br /> Governor's Office Emergency Services <br /> Hazardous Materials Spill Report <br /> DATE: 10/23/2013 RECEIVED BY: CONTROL#: <br /> TIME: 0917 Cal OES-13-6583 <br /> NRC- 1063790 <br /> La. PERSON NOTIFYING Cal OES: <br /> 1. NAME: 2. AGENCY: 3. PHONE#: 4. Ext: 5.PAG/CELL: <br /> NRC <br /> Lb. PERSON REPORTING SPILL (If different from above): <br /> 1. NAME: 2. AGENCY: 3. PHONE#: 4. Ext: 5. PAG/CELL: <br /> Unknown <br /> 2. SUBSTANCE TYPE: <br /> 2,a. b.QTY:>=4lmount Measure c.TYPE: d.OTHER: e.PIPELINEf. VESSEL <br /> SUBSTANCE: >=300 <br /> Tons <br /> 1. Motor Oil = UNK Unknown PETROLEUM No No <br /> 2. = No No <br /> 3. = No No <br /> g. DESCRIPTION:Per the NRC Report: "THIS IS A HISTORICAL RELEASE Caller is reporting oil <br /> coming out of the bathroom drain." <br /> It. CONTAINED: i. WATER j. WATERWAY: k. DRINKING WATER <br /> INVOLVED: IMPACTED <br /> Unknown Yes Home Bathroom Drain Unknown <br /> 1. KNOWN Unknown <br /> IMPACT <br /> 3. a. INCIDENT LOCATION: 931 South Oro Ave. <br /> b. CITY: c. COUNTY: d. ZIP: <br /> Stockton San Joaquin County 95215 SAN JOAQUIN VALLEY <br /> UNIFIED APCD <br /> 4. INCIDENT DESCRIPTION: <br /> a. DATE: b. TIME (Military): c. SITE: d. CAUSE <br /> 08/19/2013 1200 Residence Unknown <br /> e.INJURIES f. FATALITY g. EVACUATION h. CLEANUP BY: <br /> No No No Unknown <br /> 6.NOTIFICATION INFORMATION: <br /> a. ON SCENE: b. OTHER ON SCENE: c. OTHER NOTIFIED: <br /> d. ADMIN. AGENCY: San Joaquin County e. SEC. AGENCY: <br /> Environmental Health <br /> f.ADDITIONAL COUNTY: g. ADMIN. AGENCY: <br /> h. NOTIFICATION LIST: <br /> DOG Unit: RWQCB Unit: <br /> 513 <br /> AA/CUPA,DFG-OSPR,DTSC,RWQCB,US EPA,USFWS,COASTAL COM,CDPH-D.O,LANDS,PARKS&REC,USCG,COMP,COMM,Co/E-111th <br /> ********* Control No: 13-6583 ********* <br /> Created by: Warning Center on: 10/23/2013 09:17:16 AM Last Modified by:Warning Center on: 10/23/2013 09:21:32 AM <br /> http://w3.calema.ca.gov/operational/malhaz.nsf/fl 841 al 03c 102734882563e200760c4a/ed... 10/23/2013 <br />