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Feb 05 07 02: 18p San Joaquin County OES 2094682600 p•3 <br /> CALIFORNIA HAZARDOUS MATERIALS INCIDENT REPORT SYSTEM <br /> APAGENCYNAMEE AGENCY ID NO. INCIDENT NO. AGENCY TEL NO. DES CONTROL NOin OES 39807 IR-00308 (209)468 3962!3969 016748 <br /> TE TIME NOTIFIED TIME COMPLETED DATECOMPLETED <br /> B1518 0718 If DIFFERENT FROM <br /> INCIDENT DATE <br /> DRESS/LOCATIONCITY/COMM[;NITY COUNTY ZIP <br /> Ccoln St. @ Horton Ave. Stockton San Joaquin 95202 <br /> IWPAR MPOPERTY IISE I SURROUNDING AREA PROPERTY MANAGEMENT <br /> D 1 CLEAR 600 Industrial,Utility 400 Residential City <br /> ` REL.EASEFACTORS TYPE OFEQUIPMENT INVOLVED MOB1LEPROPERTY TY PE <br /> E 50 Mechanical Failure 77 Chem Processing Equip 98 No Mobile Property Involved <br /> ACTIONS TAKEN <br /> ri 1 41 Remove Hazard,42 Identify Haz Mat,63 Notify Other Agency. <br /> CHEMICAL OR TRADE NAME DOT ID NO. DOT HAZARD CLAS$ CAS NO, <br /> Hydrogen Peroxide 2014 5 7722-841 <br /> HYSICAL STATE I PHYSICAL STATE QUANTITY RELEASED ENVIRONMENTAL CONTAMINATION EXTENT OF <br /> RED IRELEASED RELEASE <br /> 2 Liquid 2 Liquid small amount 3 Ground 6 Property of Origin <br /> CONTAINER DESCRIPTION CONTAINER TYPE LEVEL OF CONTAINER CONTAINER MATERIAL CONTAINER CAPA <br /> Fixed 21 Tank or Silo I1 Ground Level Unknown 2200 gallon <br /> G CHEMICAL OR TRADE NAME DOT ID NO. DOT HAZARD CLASS CAS NO. <br /> PHYSICAL STATE I PHYSICAL STATE QUANTITY RELEASED ENVIRONMENTAL CONTAMINATION EXTENT OF <br /> STORED RELEASED RELEASE <br /> CONTAINER DESCRIPTION 1CONTAINERTYPF LEVEL OF CONTAINS CONTAINER MATERIAL CONTAINER CAPAC <br /> MORE THAN 2 SUBSTANCES INVOLVED? ❑YES ❑NO <br /> ADDITIONAL INFORMATION <br /> H <br /> SPECIAL <br /> LA BCD 2. A BCD 3. A B C D 4. A B C D 5. A R C D 6. ABCD <br /> I <br /> STUDIES LOCAL STATE <br /> USE — _— _ —__— _--_ <br /> HAZMAT IDENTIFICATION SOURCES 1HAZMATCASUALTIFS <br /> PERSONNEL REFERENCE MATERIAL pOp *OF *OF <br /> L J 40 On-Site Non-Fire 25 Private Info DECONTAMINATED INJURIES FATALITIES <br /> SRESPONDING 0 0 0 <br /> Services <br /> Source AGENCY PERSONNEL <br /> OTHERS 0 0 0 <br /> [VEHICLE MAKYEAR VEHICLE LICENSE NO. STATE VEHICLE ID NO.(VIN) UC/1CC NO. COMPANY NAME <br /> 6' FICA/DOT/Pj{ N/A N/A I N/A N/A NIA N/A <br /> L REPORTING OFFICER NAM&ID NO.(PRINT OR TYPE) DATE COMMENTS ATTACHED <br /> �. P Cook 12/2/1996 No <br /> V <br />