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CALIFORNIA HAZARDOUS MATERIALS INCIDENT REPORT SYSTEM <br /> AGENCY NAME AGENCY ID NO. INCIDENT NO. AGENCY TEL NO. DES CONTROL NO. <br /> San Joaquin OES 39807 XSJ-00814 (209)468-3962/3969 99-1552 <br /> INCIDENT DATE TIME NOTIFIED TIME COMPLETED DATE COMPLETED <br /> I3 4/8/1999 1045 IfDFFE,RRE TFROM <br /> INCIDENT ADDRESSILOCATION CITY/COMMUNITY COUNTYZ P <br /> L 15658 Escalon Bellota RD Escalon San Joaquin 95320 <br /> WEATHER I TEMP I PROPERTY USESURROUNDING AREA PROPERTY MANAGEMENT <br /> D 3 RAIN 650 Agricultural 500 Mercantile,Bus Private <br /> _ RELEASE FACTORS ffPEF E UIPMENT INVOLVED MOBILE PROPERTY TYPE <br /> E 99 See Comments Page o Equip Involved 98 No Mobile Property Involved <br /> ACTIONS TAKEN <br /> F 41,Remove Hazard(Neutralize)47,Decon Area(Clean up) <br /> - CHEMICAL OR TRADE NAME DOT ID NO. DOT HAZARD CLASS CAS NO. <br /> Paraquat <br /> _ HYSICAL STATE PHYSICAL STATE QUANTITY RELEASED ENVIRONMENTAL CONTAMINATION EXTENT OF <br /> TORED RELEASED RELEASE <br /> 2 Liquid 2 Liquid 1.5 gallonsi None 2 Room of Origin <br /> CONTAINER DESCRIPTION CONTAINER TYPE LEVEL OF CONTAINERCONTAINER MATERIAL CONTAINER CAPAC <br /> 2,Portable 13 Can or Bottle 11 Ground Level 5 Plastic Flexible 2.5 Gallons <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 EXTENT OF <br /> STORED RELEASED RELEASE <br /> CONTAINER DESCRIPTION CONTAINER TYPE LEVEL OF CONTAINE CONTAINER MATERIAL CONTAINER CAPACITY <br /> -- MORE THAN 2 SUBSTANCES INVOLVED? ❑YES ® NO <br /> ADDITIONAL INFORMATION <br /> H <br /> I SPECIAL <br /> STUDIES LOCAL STATE <br /> USE <br /> HAZMAT IDENTIFICATION SOURCES HAZMAT CASUALTIES <br /> _ PERSONNEL REFERENCE MATERIAL #OF #OF #OF <br /> J 40 On-Site Non-Fire98 No Reference DECONTAMINATED INJURIES FATALITIES <br /> RESPONDING 0 0 0 <br /> Services <br /> Material Used AGENCY PERSONNEL <br /> OTHERS 0 0 0 <br /> EHICLE MAKE(YEAR IVEHICLE LICENSE NO.ISTATE VEHICLE ID NO. (VIN) CA/DOT/PUCtICC NO. COMPANY NAME <br /> r K N/A <br /> L REPORTING OFFICER NAME/ID NO.(PRINT OR TYPE) DATE COMMENTS ATTACHED <br /> ,, M Parissi, OES8 4/8/1999 Yes <br />