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Jan 12 06 05: 10p San Joaquin County OES 2099449015 p. 2 <br /> CALIFORNIA HAZARDOUS MATERIALS INCIDENT REPORT SYSTEM <br /> ` AAGENCY NAME AGENCY ID NO. A'CiDENT NO. AGENCY TEL NO. OES CONTROL NO. <br /> San Joaquin OES 39807 IR-00463 (209)468-3962/3969 97-4128 <br /> INCIDENT DATE TIME NOTIFIED TIMECOMPLETED DATE COMPLETED <br /> B 10/15/1997 1300 2200 IfDIFFERBNTFROM <br /> INCIDENT DATE <br /> INCIDENT ADDRESSILOCATION CITY/COMMUNITY COUNTY ZIP <br /> C 1940 N Filbert St Stockton San Joaquin 95205 <br /> WEATHER I TEMP I PROPERTY USE Sl1RROUNDING AREA PROPERTY MANAGEMENT <br /> D I 1 CLEAR 75 1 400 Residential 400 Residential County <br /> LE <br /> FACTORS [TYPEOFE (IIPMENTINVOLVED MOBILE PROPERTY TYPE <br /> E 99 See Comments Page 99 See Comment Page 98 No Mobile Property Involved <br /> ACTIONS TAKEN <br /> ` F 82-Secure Property,42-Id/Analysis of Hazmat,63-Notify Other Agency,47-Decon-Area. <br /> CHEMICAL OR TRADE NAME DOT TO NO, DOT HAZARD CLASS CAS NO. <br /> Drug lab waste <br /> YSICALSTATE PHYSICAL STATE QUANTITY RELEASED ENVIRONMENTAL CONTAMINATION EXTENT OF <br /> _ ORED RELEASED RELEASE <br /> CONTAINER DESCRIPTION CONTAINER TYPE LEVEL OF CONTAINS CONTAINER MATERIAL CONTAINER CAPACITY <br /> G <br /> CHEMICAL OR TRADE NAME DOT IO NO. 155THAZARD CLASS CAS NO. <br /> PHYSICAL STATE PHYSICAL STATE QUANTITY RELEASED ENVIRONMENTAL CONTAMINATION EXTENT OF <br /> STORED RELEASED RELEASE <br /> CONTAINER DESCRIPTION WN iAmER TYPE LEVEL OF CONTAINS CONTAINER MATERIAL CONTAINER CAPACITY <br /> i <br /> ` MORE THAN 2 SUBSTANCES INVOLVED? ®YES ❑NO <br /> ADDITIONAL INFORMATION <br /> r <br /> LA B C D 2. A D C D 3. A B C D <br /> SPECIAL 4. A B C D 5. A B C D 6. A B C D <br /> I <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 RESPONDING DECONTAMINATED INJURIES FATALITIES <br /> Services Material Used AGENCY PERSONNEL <br /> OTHERS <br /> HICLE MAKE/YEAR IVEHICLE LICENSE NO.ISTATE IVEHTCLE ID NO.(VIN) CA/DOT/PUCACC NO. COMPANY NAME <br /> K <br /> L IREPORTING OFFICER NAME/ID NO.(PRINT OR TYPE) DATE COMMENTS ATTACHED <br /> R Lopez 1 0/1 611 99 7 Yes <br /> r <br />