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CALIFORNIA HAZARDOUS MATERIALS INCIDENT REPORT SYSTEM <br /> A AGENCY NAME AGENCY ID NO. INCIDENT NO. AGENCY TEL NO. DES CONTROL NO. <br /> San Joaquin OES 39807 XSJ-00765 (209)468-3962/3969 98-5690 <br /> INCIDENT DATE TIME NOTIFIED TIME COMPLETED DATE COMPLETED <br /> B 12/22/1998 1818 1830 INDIFFERENT <br /> ID E nnFR M 12/23/1998 <br /> INCIDENT ADDRESS/LOCATION CITY/COMMUNITY COUNTY ZIP <br /> C 18601 N. Grant Line Tracy San Joaquin 95376 <br /> WEATHER TEMP PROPERTY USESURROUNDING AREA PROPERTY MANAGEMENT <br /> D 1 CLEAR 34 400 Residential 650 Agricultural Private <br /> ` RELEASE FACTORS 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 /> ri 42,ID/Analysis of Hazmat;63,Notify Other Agency <br /> err CHEMICAL OR TRADE NAME DOT ID NO. DOT HAZARD CLASS CAS NO. <br /> Drug Lab Waste(corrosive and flamable) <br /> HYSICAL STATE PHYSICAL STATE QUANTITY RELEASED ENVIRONMENTAL CONTAMINATION EXTENT OF <br /> TORED RELEASED RELEASE <br /> CONTAINER DESCRIPTION ICONTAWER TYPE LEVEL OF CONTAINER CONTAINER MATERIAL CONTAINER CAPACITY <br /> Varoius <br /> G <br /> CHEMICAL OR TRADE NAME DOT ID NO. DOT HAZARD CLASS CAS NO. <br /> PHYSICAL STATE PHYSICAL STATE QUANTITY RELEASED ENVIRONMENTAL CONTAMINATION EXTENT OF <br /> STORED RELEASED RELEASE <br /> CONTAINER DESCRIPTION CONTAINER TYPE LEVEL OF CONTAINS I <br /> CONTAINER MATERIAL CONTAINER CAPAC <br /> MORE THAN 2 SUBSTANCES INVOLVED? ®YES ❑ NO <br /> ADDITIONAL INFORMATION <br /> H <br /> I.A B C D 2. A B C D 3. A B C D 4. A B C D 5. A B C D 6. A B C D <br /> -- I SPECIAL <br /> STUDIES LOCAL STATE <br /> USE <br /> r 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 /> Services RESPONDING <br /> ` Material Used AGENCY PERSONNEL <br /> OTHERS <br /> EHICLE MAKENBAR IVEHICLE LICENSE NO.ISTATE IVEHICLE ID NO. (VIN) I CA/DOT/PUC(ICC NO.I COMPANY NAME:j <br /> K <br /> L REPORTING OFFICER NAMEM NO.(PRINT OR TYPE) DATE COMMENTS ATTACHED <br /> R Lopez, OES7 12/24/1998 <br />