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Feb 05 07 02: 19p San Joaquin Count9 OES 2094682600 p. 6 <br /> oP4�lNi•.o 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 /> • �4l%f OSt�`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 /> 9/&2� XSJ-01145 <br /> M Initial Information Reported Wind Speed/Direction <br /> Stockton MUD reported a small hydrogen peroxide release of 3-5 gallon <br /> resulting from a hose connection leak at the Lincoln&Horton St in Stockton <br /> Reporting Party Name Address Telephone No. <br /> Diane Hinson 2500 Navy Dr. (209)937-8758 <br /> City of Stockton-MUD Stockton,CA 95206 <br /> Responsible Party Name Address Telephone No. <br /> N City of Stockton-MUD 2500 Navy Dr. (209)937-8758 <br /> Stockton,CA 95206 <br /> Responsible Parry Representative Name Address Telephone No. <br /> Diane Hinson 2500 Navy Dr. (209)937-8758 <br /> City of Stockton-MUD Stockton.CA 95206 <br /> tEmDistna <br /> m GES Personnel On Scene <br /> No Response <br /> ted? DaWTme Activated Members On Scene <br /> Mitigation/Rena,al Actions <br /> of, <br /> Take report only.Stockton MUD contained hazmat and will have supplier respond to <br /> complete cleanup. <br /> Agency Notifications and/or Referrals <br /> Name of Agency Date of Notification Time of Notification Name of Representative <br /> Notified <br /> P <br /> Reporting Officer Signature CHMIR Filed? Incident Type <br /> Yes Mobile Vehide Cargo <br /> Page 2 <br />