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Feb 16 06 09: 56a San Joaquin Counts OES 2099449015 P. 15 <br /> CALIFORNIA HAZARDOUS MATERIALS INCIDENT REPORT SYSTEM <br /> — 4 AGENCY NAME AGENCY ID NO. INCIDENT NO. AGENCY TEL NO. OFS CONTROL NO. <br /> San Joaquin OES 39807 XSJ-01244 (209)468-396213969 Not Assigned <br /> INCIDENT DATE TIME NOTIFIED TIME COMPLETED DATE COMPLETED <br /> _ B 2/14/2001 1230 1530 If INCIDENT DIFFERENT FROM <br /> INCIDENT ADDRESS/LOCATION CITY/COMMUNITY COUNTY ZIP <br /> C 3901 E.Miner Stockton San Joaquin 95215 <br /> WEATHERTEMP I PROPERTY USE I S -RROUNDINO AREA 1PROPERTYMANAGEMENT <br /> D 1 CLEAR 400 Residential 400 Residential Private <br /> REL . F 5 TYPE OF EQUIPMENT INVOLVED MOBILE PROPERTY TYPE <br /> E 98 No Release 98 No Equip Involved 98 No Mobile Property Involved <br /> ACTIONS TAKEN <br /> F 64 Provide Public Info. <br /> CHEMICAL OR TRADE NAME DOT ID NO. DOT HAZARD CLASS CAS NO. <br /> Clandestine Drug Lab Chemicals <br /> PHYSICALSTATE I PHYSICAL STATE I QUANTITY RELEASED ENVIRONMENTAL CONTAMINATION 7ffFENT OF <br /> TORED RELEASED RELEASE <br /> Various <br /> CONTAINER DESCRIPTION CONTAINER TYPE LEVEL OF CONTAINER CONTAINER MATERIAL CONTAINER CAPACITY <br /> Various Various Various Various Various <br /> G <br /> CHEMICAL OR TRADE NAME DOT ID NO. DOT HAZARD CLASS CAS NO. <br /> PHYSICALSTATE PHYSICAL STATE QUANTITY RELEASED ENVIRONMENTAL CONTAMINATION EXTENT OF <br /> STORED RELEASED RELEASE <br /> ` CONTAINER DESCRIPTION [ONTADIPR TYPE LEVEL OF CONTAINEI CONTAINER MATERIAL JCONTAINERCAPACITY <br /> MORE THAN 2 SUBSTANCES INVOLVED? ❑YES ❑NO <br /> ADDITIONAL INFORMATION <br /> H <br /> 1.A BCD 2 A B C D 3. A B C D 4. A R C D 5. A R C D 6, A B C D <br /> Z SPECIAL <br /> STUDIES LOCAL STATE <br /> USE — _ - - _ —— __ __—_ __- - —— — — <br /> HAZMAT IDENTIFICATION SOURCES HAZMAT CASUALTIES <br /> PERSONNEL REFERENCE MATERIAL #OF #OF #OF <br /> J 60 Off-Site Non-Fire 98 No Reference DECONTAMINATED INJURIES FATALITIES <br /> RESPONDING N/A N/A N/A <br /> Services Material Used AGENCY PERSONNEL <br /> OTHERS N/A NIA NIA <br /> HICLE MAKE/YEAR IVEHICLE LICENSE NO.ISTATE IVEHICLE ID NO.(VIN) ICAIDOTIPUCACCNO.1 COMPANY NAME <br /> K I N/A I N/A N/A N/A I NIA N/A <br /> ](. IREPORTING OFFICER NAME/ID NO.(PRINT OR TYPE) DATE COMMENTS ATTACHED <br /> R Lopez,OES7 3/3/2001 YES <br />