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Feb 23 05 10c23a San Joaquin County OES 2034682600 P.6 <br /> CALIFORNIA HAZARDOUS MATERIALS INCIDENT REPORT SYSTEM <br /> A AGENCY NAME AGENCY ID NO. INCIDENT NO. AGENCY TEL NO. OES CONTROL NO. <br /> ` San Joaquin OES 39807 IR-00459 (209)468-3962/3969 <br /> INCIDENT DATE TIME NOTIFIED TIME COMPLETED DATE COMPLETED <br /> B 10!11/1997 1$00 1930 NDIFFERENTFROM <br /> INCIDENT DATE <br /> INCIDENT ADDRESSILOCATION CITY/COMMUNITY COUNTY ZIP <br /> C 226 S. Anteros Stockton San Joaquin <br /> WEATriERTEMP PROPERTY USE SURROUNDING AREA PROPBRTY MANAGEMENT <br /> r D <br /> I CLEAR 65 400 Residential 400 Residential Private <br /> IRELEASEFACMR5 ITYPE OF EQUIPMENT INVOLVED IMOBILE PROPERTY TYPE <br /> 31 Abandoned 98 No Equip involved 98 No Mobile Property involved <br /> ACTIONS TAKEN <br /> ` F 141,Remove Hazard(Neutralize);42,ID/Analysis of HazMat:97,HazMat response,material determined to be <br /> nonhazardous <br /> f CHEMICAL OR TRADE NAME DOT ID NO. DOT HAZARD CLASS CAS NO. <br /> r <br /> YSICAL STATEPHYSICALSTATE I QUANTITY RELEASED ENVIRONMENTAL CONTAMINATION EXTENT OF <br /> TORED RELEASED RELEASE <br /> r <br /> CONTAINER DESCRIPTION rTAINERTYPE LEVEL OF CONTA7 CONTAINER MATERIAL rNTAINER CAPACITY <br /> G CHEMICAL OR TRADE NAME DOT 10 NO. DOT HAZARD CLASS CAS NO. <br /> PHYSICAL STATE I PHYSICAL STATE I QUANTITY RELEASED ENVIRONMENTAL CONTAMINATION EXTENT OF III <br /> STORED RELEASED RELEASE <br /> CONTAINER DESCRIPTION CONTAIN R TYPE LEVEL OF CONTAINE CONTAINER MATERIAL CONTAINER CAPACI <br /> MORE THAN 2 SUBSTANCES INVOLVED? ❑YES ®NO <br /> r, ADDITIONAL INFORMATION <br /> items were uncontaminated Clan Lab items such as funnels,plastic containers,etc. <br /> SPECIAL <br /> I.A B C D 2. A BCD 3. A B C D 4. A R C D 5. A B C D 6. A R C D <br /> a <br /> STUDIES LOCAL STATE <br /> USE _ ___ — _ —_ _- -- ———— <br /> — __ _ _ - - _ <br /> HAZMAT IDENTIFICATION SOURCES HAZMAT CASUALTIES <br /> PERSONNEL REFERENCE MATERIAL #OF #OF #OF <br /> J 40 Oa-Site Non-fire 98 No Reference RESPONDING DECONTAMINATED INJURIES FATALITIES <br /> Services Material Used AGENCY PERSONNEL ---- <br /> OTHERS <br /> �fiH[C1.E MAKFIYEAR IVEHICLE LICENSE NO.ISTATE IVEHICLE ID NO.(VIN) CA/DOT/PUCACCNO. COMPANYNAMF <br /> K I N/A <br /> REPORTING OFFICER NAME/ID NO.(PRINT OR TYPE) DATE COMMENTS ATTACHED <br /> M Parissi 10/12/1997 No <br />