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Feb 23 05 10: 22a San Joaquin County UES 2094682600 P. 3 <br /> CALIFORNIA HAZARDOUS MATERIALS INCIDENT REPORT SYSTEM <br /> A AGENCY NAME AGENCY ID NO. INCIDENT NO. AGENCY TEL NO. OES CONTROL NO. <br /> San ioaquin OES 39807 XSI-01244 (209)468-3962/3969 Noe Asswned <br /> WCIDENTDATE TIMENOTIFIED TIME COMPLETED DATE COMPLETED <br /> B 2/14/2001 1230 1530 If DIFFERENT FROM <br /> INCIDENT DATE <br /> INCIDENT ADDRESSILOCA71ON CITY/COMMUNITY COUNTY ZtP <br /> 39 <br /> 011 E.Miner Stockton Sanioaquia 95215 <br /> _ I WEATHER TEMP PROPERTY USE I SURROUNDING AREA PROPERTY MANAGEMENT <br /> D 1 CLEAR 400 Residential 400 Residential Private <br /> RELEASEFACTORS ITYPE OPEQUIPMENT INVOLVEDMOBILE PROPERTYTYPE -_ <br /> E 98 No Release 98 No Equip Involved 98 No Mobile Property Involved <br /> ACTIONS TAKEN <br /> r F 1 64 Provide Public Info. <br /> CHEMICAL OR TRADE NAME DOT ID NO. DOT HAZARD CLASS CAS NO. <br /> Clandestine Drug Lab Chemicals E <br /> r <br /> 'HYSICAL STATE �PHYSICALSTATE QUANTITY RELEASED ENVIRONMENTAL CONTAMINATION EXTENT OP <br /> RED RELEASED - RELEASE <br /> r Various <br /> CONTAINER DESCRIPTION CONTAINER TYPE LEVEL OF CONTAINER CONTAINER MATERIAL CONT.41N[:it CAPACITY <br /> Various Various Various Various Various <br /> r CHEMICAL OR TRADE NAME DOT ID NO. DOT HAZARD CLASS CAS NO. <br /> PHYSICAL STATE PHYSICAL STATE QUANTITY RELEASED ENVIRONMENTAL CONTAMINATION EXTENT OF <br /> r STORED RELEASED RELEASE <br /> CONTAINER DESCRIPTION CONTAINER TYPE LEVEL OF CONTAINS CONTAINER MATERIAL CONTAINER CAPACITY <br /> MORE THAN 2 SUBSTANCES INVOLVED? ❑YES ❑NO <br /> ADDITIONAL INFORMATION <br /> r <br /> SPECIAL I.A BCD 2 A B C D 3. A B C D 4. A B C D 5. A BCD C. A BCD <br /> I <br /> STUDIES LOCAL STATE <br /> USE ____ _ ___ <br /> r HAZMAT IDENTIFICATION SOURCES HAZMAT CASUALTIES <br /> PERSONNEL REFERENCE MATERIAL IOF #OF 4OF <br /> j 60 Off-Site NOn-Fire98 No Reference DECONTAMINATED INi URIES FATALiTIESI <br /> Services RESPONDING N/A N/A NIA <br /> Material Used AGENCY PERSONNEL <br /> OTHERS N/A N/A NIA <br /> EHICLE MAKFIYEAR IVEHICLE LICENSE NO,ISTATE IVEHICLE ID NO.(VIN) ICAIDOTIPUCICCNO.1 COMPANY NAME <br /> r <br /> K I N/A I NIA I N/A N/A I NIA I N/A <br /> r <br /> IL <br /> REPORTING OFFICER NAMEnD NO.(PRINT OR TYPE) DATE COMMENTS ATTACHED <br /> R Lopcz,OES7 3/3/2001 YES <br /> r <br />