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Jan 04 06 04: 15p San Joaquin County OES 2094682600 p. 10 <br /> oP�'"`"..•c SAN JOAQUIN COUNTY-OFFICE OF EMERGENCY SERVICES <br /> HAZARDOUS MATERIALS DIVISION <br /> 222 East Weber Avenue,Room 610,Stockton, CA 95202 <br /> Telephone (209)468-3969 <br /> C4�lROtta`P <br /> ADDENDUM TO <br /> CALIFORNIA HAZARDOUS MATERIALS INCIDENT REPORT <br /> Date incident Occured Time Incident Date At Scene Time At Scene SJOES Incident No. <br /> Occured <br /> 12/13/2001 1318 12/13/2001 1445 XSJ-01521 <br /> initial Information Reported Wind Speed/Direction <br /> Abandoned clan lab related items. South at 8 <br /> Reporting Party Name Address Telephone No. <br /> Wayne Fillipowski 7000 M. Canlis Blvd. 209-468-4401 <br /> San Joaquin Co. SO French Camp,CA 95231 <br /> Responsible Parry Name Address Telephone No. <br /> N Unknown <br /> Responsible Party Representative Name Address Telephone No. <br /> Unknown <br /> OES HazMat Team OES Personnel On Scene <br /> Activated <br /> Parissi <br /> NO <br /> Joint Team Activated? Date/Time Activated Members On Scene <br /> O NO <br /> Fire District Miti-gation/Removal Actions <br /> 02 Ripon AL1 materials removed by DTSC contractor. <br /> Agency Notifications and/or Referrals <br /> Name of Agency Date of Notification Time of Notification Name of Representative <br /> Notified <br /> DTSC 12/13/01 1501 Carlos Ortega <br /> State Warning Center 12/13/01 1617 Sibyl Clark <br /> P <br /> Reporting Officer Signature CHMIR Filed? Incident Type <br /> Q yes Abandoned Drug Lab Related Materials <br /> ._ Page 2 <br />