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CALIFORNIA HAZARDOUS MATERIALS INCIDENT REPORT SYSTEM <br /> AAGENCY NAME AGENCY ID NO. JINCIDENT NO. AGENCY TEL NO. OES CONTROL NO. <br /> San Joaquin OES 39807 XSJ-01556 (209)468-3962/3969 02-0807 <br /> INCIDENT DATE TIME NOTIFIED TIME COMPLETED DATE COMPLETED <br /> B 2/11/2002 1229 1400 IT DIFFERENT FROM <br /> INCIDENT DATE <br /> INCIDENT ADDRESS/LOCATION CITY/COMMUNITY COUNTY ZIP <br /> C North end of Anteros at Myrtle Stockton San Joaquin 95215 <br /> WEATHER I TEMP I PROPERTY USE I SURROUNDING AREA IPROPERTY MANAGEMENT <br /> D I 1 CLEAR 68 400 Residential 400 Residential City <br /> RELEASE FACTORS ITYPE OFEQUIPMENT INVOLVED MOBILE PROPERTY TYPE <br /> H, 31 Abandoned 99 See Comment Page 99 See Comment Page <br /> ACTIONS TAKEN <br /> F 1 42- ID analysis of Hazmat;41 -Remove hazard <br /> CHEMICAL OR TRADE NAME DOT ID NO, DOT HAZARD CLASS CAS NO. <br /> Waste oil with water 1270 3 Flammable Mixture <br /> Liquids <br /> HYSICAL STATE PHYSICAL STATE QUANTITY RELEASED I ENVIRONMENTAL CONTAMINATION JEXTENT OF <br /> TORED RELEASED RELEASE <br /> 2 Liquid 2 Liquid <1/2 quart 3 Ground 6 Property of Origin <br /> - CONTAINER DESCRIPTION CONTAINER TYPE LEVEL OF CONTAINER CONTAINER MATERIAL CONTAINER CAPAC <br /> 2 Portable Bucket 11 Ground Level 4 Plastic/Fiberglass, 5 Gallons <br /> G Rigid <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 CONTAINER MATERIAL CONTAINER CAPACITY <br /> MORE THAN 2 SUBSTANCES INVOLVED? ❑YES ®NO <br /> ADDITIONAL INFORMATION <br /> H <br /> 1.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 /> SPECIAL <br /> I STUDIES LOCAL STATE <br /> _ — _ <br /> HAZMAT IDENTIFICATION SOURCES HAZMAT CASUALTIES <br /> PERSONNEL REFERENCE MATERIAL #OF #OF #OF <br /> J 40 On-Site Non-Fire 99 See Comments RESPONDING DECOINJURIES 0 <br /> FAT0 TIES <br /> Services Page AGENCY PERSONNEL. <br /> OTHERS N/A N/A N/A <br /> EHICLE MAKEIYEAR IVEHICLE LICENSE NO.ISTATE IVEHICLE ID NO. (VIN) ICA/DOT/PUC/1CCNO.l COMPANY NAME <br /> K I N/A I N/A N/A N/A N/A N/A <br /> L IREPORTING OFFICER NAMFAD NO.(PRINT OR TYPE) DATE COMMENTS ATTACHED <br /> A Bentley,OESS <br /> 2/11/2002 YES <br /> L <br />