CO0004595 - Laserfiche WebLink

Home Browse Search

j D.PROPERTY USE AND SURROUNDING AREA TYPE CODES G.EXTENT OF RELEASE 100 Public assembly 762 Hazmat Chem mfg 950 Railroad 1 Confined to vehicle/equipment Educational 767 Petroleum refinery 96T Freeway 2 Confined to room of origin Health care 800 Storage 962 County/City road 3 Confined to floor of origin 400 Residential 931 Open land 963 Private road 4 Confined to structure of origin 500 Mercantile,Business 936 Vacant lot 965 Rest stoplvista point 6 Confined to property use of origin 600 Industrial,Utility 941 Open sea 966 Scalefinspection facility 7 Release beyond property use of origin 650 Agricultural 942 Harbor/Port 099 Other(explain in 8 NO RELEASE 700 Manufacturing 946 Lake/Pond/River Comments) 9 Other(explain in Comments section) G.CONTAINER TYPE LEVEL OF CONTAINER G.CONTAINER MATERIAL 11 Drum 24 Machinery or process equipment 11 Ground level 1 Iron and iron alloys 12 Cylinder 31 Sump/Pit 30 Above ground 2 Aluminum and aluminum alloys 13 Can or bottle 32 Pond or surface impoundment 40 Below ground 3 Copper and copper alloys 14 Carboy 33 Well 4 Plastic(includes fiberglass),rigid 15 Box or carton 41 Vehicular fuel tank 5 Plastic,flexible 16 Bag 98 NO CONTAINER 6 Wood,paper,and cellulose products 21 Tank or silo(including 99 Other(explain in Comments 7 Glass vehicle cargo tanks) Section) 9 Other(explain in Comments) 22 Pipe 00 Undetermined 0 Undetermined I JUDICIAL DISTRICT BEAT NCIC NUMBER PLACARDS REQUIRED PHOTOGRAPHS Mangy 14 9265 ❑ Yes ❑ Na 0 Yes ❑ No MILEPOST INFORMATION TIME O.E.S.NOTIFIED TIME CALTRANSICOUNTY ROADS NOTIFIED M ❑ Feet _ of milepost 0617 0617 ❑At intersection with Mariposa Road El Or..5 miles Feet/mile' East of milepost of Wagoner Road CARRIER'S NAME PHONE NUMBER(INCLUDEAREA CODE) Bo ett Petrolium (209) 545-1122 N ADDRESS(INCLUDE CITY,STATEAND ZJP CODE) 4230 Kiernan Ave. Suite 200 Modesto CA. 95356 DRIVER'S NAME TDO587421 CENSE NUMBER AND STATE PHONE NUMBER(INCLUDE AREA CODE) r'ranklin D. Gates (209) 898-8602 " ADDRESS(INCLUDE CITY.STATE AND ZJP COOP 19238 E. UM. 120 Ripon CA. 95366 CHP NUMBER PUC NUMBER Enter at least one of - CA 1 4 0 7 1 P either the CHP, DOT,, DOT NUMBER ICC NUMBER PUC, or ICC number. :: I US MC `°` .rr. If applicable,enter cargo tank specification number and/or at least one of the following: CARGO TANK Q SPECIFICATION NUMBER 1, CHP cargo tank registration number CT... 114166 DOT-E MC 3 1 0 1 6 2. DHS Waste Hauler Compliance Sticker number CITATION ISSUED OR COMPLAINT TO BE FILED OTHER HAZARDOUS MATERIALS VIOLATIONS(NON-CAUSAnVE) Q Yes ❑ No ❑ Not determined ❑ Yes Q No PRIMARY CAUSE OF INCIDENT DID WEATHER CONTRIBUTE TO EITHER CAUSE ANDIOR SEVERITY OF INCIDENT? R E3 Violation 34506(b)VC/C.C.R.Section El Yes Q No AFTER ACTION REPORT REQUIRED?(REFER TO G.0.100.78) Q Other Code violation 21650 VC ❑ Yes Q No COLLISION REPORT MADE? NUMBER ❑ Other cause* Q Yes ❑ No 195-09-67 DATE AND TIME SCENE DECLARED SAFE I BY WHOM(NAME,TITLE AND AGENCY) 09/06/95 13 00 Harlan Knoll, Environmental Health Specialist, San Joa in Copty Health Department tSI ROAD CLOSURE None Q Full—Hours 63 ❑ Partial—Hours: Q Alternative route—Hours63 Complete narrative on CHP 556 T ELEMENTS(AS APPLICABLEJ:(IF MORE THAN ONE CARRIER OR MORE 774AN THREE COMMODTIES ARE INVOLVED,INCLUDE ADDITIONAL INFORMAT70N IN NARRAnVE.) 1. Sequence of events 3. Evacuation details 5. Cleanup actions 7. CHP personnel data—name,rank,I.D.no.,function, 2. Road closures 4. Environmental impact 6. Actions of other agencies exposure,hours PREPARERS NAME,RANK,AND LD.NUMBERDATE REVIEWER'S NAME,RAN D I.D.NUMBER DATE , Don Pe Ser eant, (14160 09/10/95 _ - 1