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Feb 05 07 02: 19p San Joaquin County OES 2094662600 p. 5 <br /> CALIFORNIA HAZARDOUS MATERIALS INCIDENT REPORT SYSTEM <br /> n.. AAGENCY NAME AGENCY ID NO. MINCIDENT NO. AGENCY TEL NO. OES CONTROL NO. <br /> San Joaquin OES 39807 1 XSJ-01145 (209)468-3962/3969 <br /> INCIDENT DATE TIME NOTIFIED TIME COMPLETED DATE COMPLETED <br /> 9/82000 1048 1048 If DIFFERENT FROM <br /> INCIDENT DATE <br /> INCIDENT ADDRESS/LOCATION CITY/COMMUNITY COUNTY ZIP <br /> C I <br /> Lincoln Stand Horton St IStockton San Joaquin 95206 <br /> WEATHER TEMI° I PROPERTY USE ISURROUNDING AREA PROPERTY MANAGEMENT <br /> D 1 CLEAR <br /> RELEASE FACTORS ITYPS OF EQUIPMENT INVOLVEDMOBILE PROPERTY TYPE <br /> E 50 Mechanical Failure 96 Hazmat Transfer Equip 99 See Comment Page <br /> A(MONS TAKEN <br /> F I 99—Take Report <br /> ` CHEMICAL OR TRADE NAME DOT ID NO. DOT HAZARD CLASS CAS NO. <br /> Hydrogen Peroxide(50% solution) 2014 5 Oxidizers and <br /> Organic peroxides <br /> HYSICALSTATE 1PHYSICALSTATE QUANTITY RELEASED ENVIRONMENTAL CONTAMINATIONEXTENTOF <br /> 6. RED IRELEASED RELEASE <br /> 2 Liquid 2 Liquid 3-5 Gallons 9 Other 4 Structure of Origin <br /> CONTAINER DESCRIPTION CONTAINER TYPE LEVEL OF CONTAN CONTAINER MATERIAL CONTAINER CAPACITY <br /> ` 3,3 Mobile&Armored 21 Tank or Silo 30 Above Ground 1 Iron,Steel,Alloys Unknown <br /> G CHEMICAL OR TRADE NAME DOT ID NO. DOT HAZARD CLASS CAS NO. <br /> I <br /> ` PHYSICAL STATE I PHYSICAL STATE I QUANTITY RELEASED ENVIRONMENTAL CONTAMINATION EXTENT OF <br /> STORED RELEASED RELEASE <br /> L CONTAINER DESCRIPTION CONTAINER TYPE LEVEL OF CONTAINS CONTAINER MATERIAL CONTAINER CAPACITY <br /> L MORE THAN 2 SUBSTANCES INVOLVED? ❑YES ®NO <br /> ADDITIONAL INFORMATION <br /> H <br /> SPECIAL LA B C D 2. A B C D 3. A R C D 4. A B C D 5. A R C D 6. A B C D <br /> F <br /> STUDIES LOCAL STATE <br /> USE ---_ — — _ — _ __— __-- __ _ _ <br /> HAZMAT IDENTIFICATION SOURCES HAZMAT CASUALTIES <br /> PERSONNEL REFERENCE MATERIAL #OF #OP #OP <br /> ITI <br /> J 99 See Comments Page 99 See COmmenlS DECONTAMINATED INJURIES FATALES <br /> ` RESPONDING 0 0 0 <br /> Page AGENCY PERSONNEL <br /> OTHERS 0 0 0 <br /> EHICLE MAKE(YEAR IVEHICLE LICENSE NO.ISTATE VEHICLE ID NO.(VIN) ICAIDOTIPUOICCNO.1 COMPANY NAME <br /> K I N/A I N/A I N/A I N/A I N/A N, <br /> L IREPORTING OFFICER NAME/ID NO.(PRINT OR TYPE) DATE COMMENTS ATTACHED <br /> r. A Bentley,OES5 9/11/2000 YES <br /> r <br />