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Sep 22 06 09: 40a San Joaquin County OES 2094682600 p. 3 <br /> CALIFORNIA HAZARDOUS MATERIALS INCIDENT REPORT SYSTEM <br /> AAGENCY NAME AGENCY ID N0. JINCIDENT NO. AGENCY TEL NO. OES CONTROL NO. <br /> San Joaquin OES 39807 XSJ-01413 (209)468-3962/3969 Not assigned <br /> INCIDENT DATE I TIME NOTIFIED TIME COMPLETED DATE COMPLETED <br /> B 9/6/2001 0850 1045 if DIFFERENT FROM <br /> INCIDENT DATE <br /> INCIDENT ADDRESS/LOCATION CITY/COMMUNITY COUNTY ZIP <br /> C Thornton Rd. Unincorporated San Joaquin 95686 <br /> WEATHER I TEMPPROPERTY USE SURROUNDING AREA 1PROPERTY MANAGEMENT <br /> D 1 CLEAR 936 Vacant Lot 100 Public Assembly 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 /> F 64 Provide Public Info,92 Referred to Proper Authority,97 Haz Mat Response,Material Determined to be Non <br /> Hazardous <br /> _ CHEMICAL OR TRADE NAME DOT ID NO. DOT HAZARD CLASS CAS NO. <br /> Purge Water <br /> PHYSICAL STATE PHYSICAL STATE QUANTITY RELEASED ENVIRONMENTAL CONTAMINATION EXTENT OF <br /> _ STORED RELEASED RELEASE <br /> 8 NO RELEASE <br /> CONTAINER DESCRIPTION CONTAINER TYPE LEVEL OF CONTAINER CONTAINER MATERIAL CONTAINER CAPACITY <br /> 2 Portable 11 Drum 11 Ground Level 5 Plastic Flexible <br /> 55 Gallons <br /> G 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 CONTAINER CONTAINER MATERIAL CONTAINER CAPACIT <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 BCD 5. A BCD 6. A B C D <br /> I SPECIAL <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 DECONTAMINATED INJURIES FATALITIES <br /> RESPONDING N/A N/A N/A <br /> Services Material Used AGENCY PERSONNEL <br /> OTHERS N/A N/A N/A <br /> EHICLE MAK&YEAR IVERICLE LICENSE NO.ISTATE IVEHICLE ID NO. (VIN) CA/DOT/PUCACC NO. COMPANY NAME <br /> K N/A NIA N/A N/A N/A N/A <br /> L REPORTING OFFICER NAME/ID NO.(PRINT OR TYPE) DATE COMMENTS ATTACHED <br /> R Lopez,OES7 9/6/2001 NO <br /> ti <br />