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Feb 16 06 09: 57a San Joaquin County OES 2099449015 P. 18 <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-00336 (209)468-3962/3969 <br /> INCIDENT DATE TIME NOTIFIED TIME COMPLETED DATE COMPLETED <br /> B 2/27/1997 1630 1800 If DIFFERENT FROM <br /> _ INCIDENT DATE <br /> INCIDENT ADDRESSILOCATION CITY/COMMUNITY COUNTY ZIP <br /> C <br /> 1639 Oro Lane Stockton San Joaquin 95215 <br /> r W ATHERTEMPI PROPERTY USE SI;RRO1 ND1NG AREA PROPER ANAGEMENT <br /> D 1 CLEAR 60 962 County/City Road 400 Residential County <br /> RELEASEFAC'TORS EOF EQUIPMENT INVOLVED JMORILFPROPERTYTYPE <br /> E 31 Abandoned 98 No Equip Involved 98 No Mobile Property Involved <br /> ACTIONS TAKEN <br /> F 1 41,Remove hazard;ID/Analysis of hazmat <br /> CHEMICAL OR TRADE NAME DOT ID NO, DOT HAZARD CLASS CAS NO, <br /> Drug Lab Waste <br /> HYSICALSTATE PHYSICALSTATE QUANTITY RELEASED ENVIRONMENTAL CONTAMINATION EXTENT OF <br /> RED RELEASED RELEASE <br /> 1 Solid 8 NO RELEASE <br /> CONTAINER DESCRIPTION CONTAINER TYPE LEVEL OF CONTAINERCONTAINER MATERIAL CONTAINER CAPACITY <br /> Portable 11 Drum 11 Ground Level 4 Plastic/Fiberglass, <br /> G Rigid 5 gallon <br /> CHEMICAL OR TRADE NAME DOT ID NO. DOT HAZARD CLASS CAS NO. <br /> N/A <br /> +� PHYSICAL STATE PHYSICAL STATE QUANTITY RELEASED ENVIRONMENTAL CONTAMINATION JEXTENT OF <br /> STORED RELEASED RELEASE <br /> CONTAINER DESCRIPTION CONTAIN R TYPE LEVEL OF CONTAINS CONTAINER MATERIAL CONTAINER CAPACI <br /> MORE THAN 2 SUBSTANCES INVOLVED? ❑YES ❑NO <br /> ADDITIONAL INFORMATION <br /> H NO. <br /> I.A B C D 2. A B C D 3. A R C D 4. A B C D 5. A B C D 6. A B C D <br /> F SPECIAL <br /> STUDIES LOCAL STATE <br /> USE <br /> HAZMAT IDENTIFICATION SOURCES HAZMAT CASUACI'IES <br /> PERSONNEL REFERENCE MATERIAL #OF NOF A OF <br /> J 19 On-Site Fire Services Hazcat RESPONDING DECONTAMINATED INJURIES FATALITIES <br /> � AGENCY PERSONNEL <br /> OTHERS <br /> VEHICLE MAKFIYEAR IVEHICLE LICENSE NO. STATE IVEHICLE ID NO.(VW) 1CA1DOT/PUC/ICCNO.l COMPANY NAME <br /> K <br /> L REPORTING OFFICER NAMFIID NO.(PRINT OR TYPE) DATE COMMENTS ATTACHED <br /> Michael Parissi 2/28/1997 No <br />