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CALIFORNIA HAZARDOUS aTERIALS INCIDENT REPORT lSTEM <br /> AAGENCY NAME AGENCY ID NO. INCIDENT NO. AGENCY TEL NO. OES CONTROL NO. <br /> San Joaquin OES 39807 XSJ-01499 (209)468-3962/3969 Not Assigned <br /> INCIDENT DATE TIME NOTIFIED TIME COMPLETED DATE COMPLETED <br /> 11/18/2001 1330 1500 If DIFFERENT FROM <br /> INCIDENT DATE <br /> INCIDENT ADDRESS/LOCATION CITY/COMMUNITY COUNTY ZIP <br /> C I <br /> W. side of Jack Tone Rd., 1/4 mi.N. of Wildwood Rd. Unincorporated San Joaquin 95215 <br /> WEATHER TEMP PROPERTY USE I SURROUNDING AREA IPROPERTY MANAGEMENT <br /> D 1 CLEAR 962 County/City Road 650 Agricultural County <br /> r98 <br /> LEASE FACTORS TYPE OF EQUIPMENT INVOLVED MOBILE PROPERTY TYPE <br /> E No Release 98 No Equip Involved 98 No Mobile Property Involved <br /> ACTIONS TAKEN <br /> F 36—Transport;97_Hazmat response,material determined to be nonhazardous <br /> CHEMICAL OR TRADE NAME DOT ID NO. DOT HAZARD CLASS CAS NO. <br /> Empty Clandestine Lab containers <br /> (Alcohol/Acetone) <br /> HYSICAL STATE PHYSICAL STATE QUANTITY RELEASED ENVIRONMENTAL CONTAMINATION EXTENT OF <br /> TORED RELEASED RELEASE <br /> CONTAINER DESCRIPTION CONTAINER TYPE LEVEL OF CONTAINER CONTAINER MATERIAL CONTAINER CAPACIT <br /> 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 CONTAINS CONTAINER MATERIAL CONTAINER CAPACITY <br /> MORE THAN 2 SUBSTANCES INVOLVED? ❑YES H NO <br /> ADDITIONAL INFORMATION <br /> H <br /> 1.A B C D 2. A BCD 3. ABCD 4. A B C D 5. A B C D 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 <br /> Material Used AGENCY PERSONNEL <br /> OTHERS N/A N/A N/A <br /> EHICLE MAKE/YEAR VEHICLE LICENSE NO.ISTATE IVEHICLE ID NO.(VIN) CA/DOT/PUC/ICC NO. COMPANY NAME <br /> K N/A N/A N/A N/A N/A N/A <br /> L. IREPORTING OFFICER NAME/ID NO.(PRINT OR TYPE) DATE COMMENTS ATTACHED <br /> R Lopez, OES7 11/28/2001 YES <br />