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State of California—California Environmental Protection Agency <br /> Department of Toxic Substances Control <br /> OFF-HIGHWAY EMERGENCY REMOVAL INCIDENT REPORT <br /> DISC Duty Officer: Nancy McGee ERER#2017-05-03 <br /> Date of Incident: 5/12/2017 Time: 0930 <br /> Address: Harney Lane zip: 95240 <br /> Descriptive Location: Harney Lane 100 yards east of Locust Tree Rd. <br /> HAZARDOUS MATERIALS ATTACH ADDITIONAL SHEETS IF NECESSARY <br /> SUBSTANCE QUANTITY HAZCAT RESULTS <br /> Fungicide residue in bottles 14 NA <br /> RESPONSIBLE PARTY (NAME, DRIVERS LICENSE NUMBER, DATE OF BIRTH,VEHICLE REGISTRATION NUMBER,ADDRESS, PHONE) : <br /> None <br /> DESCRIPTION OF MITIGATION MEASURES (ISOLATION,EVACUATION,CROWD CONTROL): <br /> Collect plastic bottles transport to Household Hazardous Waste facility <br /> REPORT BY:Jamie Lima TITLE: Hazardous Materials Specialist <br /> OFFICE PHONE: (209) 953-6211 AGENCY: San Joaquin County Environmental Health <br /> I CERTIFY THAT THIS INCIDENT REQUIRED IMMEDIATE CORRECTIVE ACTION NECESSARY TO REME Y OR PREVENT AN EMERGENCY <br /> RESULTING FROM EITHER A FIRE,AN EXPLOSION,OR HUMAN EXPOSURE TO H ARD ES: <br /> SIGNATURE: <br /> DTsc 1203 (8/02) <br />