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Mar 08 06 09: 03a San Joaquin Countu OES 2094682600 p. 4 <br /> �f <br /> CALIFORNIA HAZARDOUS MATERIALS INCIDENT REPORT SYSTEM <br /> AGENCY NAME AGENCY ID SIO. INCIDENT NO- AGENCY TEL NO. OES CONTROL NO. <br /> A <br /> San Joaquin OES 39807 XSJ-01273 209)468-396213969 01-1902 <br /> INCIDENT DATE I TIME NOTIFIED TIME COMPLETED DATE COMPLETED <br /> B313 II2001 0945 1840 If DIFFERENT FROM <br /> INCIDENT DATE <br /> INCIDENT ADDRESSILOCATION CITY/COMMUNITY COUNTY Z]P <br /> C I <br /> Lane Oak Road east of Sexton Road Unincorporated San Joaquin <br /> WEATHER I TEMP I PROPERTY USE I SURROUNDING AREA I PROPERTY MANAGEMENT <br /> D 1 CLEAR 80 962 County/City Road 650 IAgricultural County <br /> Ff RELEASE FACTORS TYPE OF E EIPMENT INVOLVED MOBILSPROPERTY TYPE <br /> E 31 Abandoned 98 No Equip Involved 98 No Mobile Property Involved <br /> fll <br /> ACTIONS TAKEN <br /> F 41_Remove haz ard(Neutrali ze);44—Establish Safe Area;63—Notify other agency;99—Other Oversee DTSC <br /> contractor r m val <br /> CHEMICAL OR TRADE NAME DOT ID NO. DOT HAZARD CLASS CAS NO. <br /> Clan Lab contaminated trash <br /> YHYSICALSTATE PHYS(CAL STATE QUANTITY RELEASED ENVIRONMENTAL CONTAMINATION JEXTENT OF <br /> f <br /> P', GRED RELEASED RELEASE <br /> f <br /> None 8 NO RELEASE <br /> 4 r, CONTAINER DESCRTP'TION CONTAINER TYPE LEVEL OF CONTAINERCONTAINER MATERIAL CONTAINER CAPACITY <br />! t{ 2,Portable 11 Ground Level <br /> G CHEMICAL OR TRADE NAME DOT ID NO. DOT HAZARD CLASS CAS NO. <br /> NIA <br /> PHYSICAL STATE PHYSICAL STATE QUANTITY RELEASED ENVIRONMENTAL CONTAMINATION EXTENT OF <br /> STORED RELEASED RELEASE <br /> 4 <br /> CONTAINER DESCRIPTION CONTAINER TYPELSV SL OF CONTAINS CONTAINER MATERIAL CONTAINER CAPACITY <br /> E <br /> MORE THAN 2 SUBSTANCES INVOLVED? []YES ®NO <br /> ADDITIONAL INFORMATION <br /> li <br /> H <br /> 1.A B C D 2. A B C D 3. A R C D 4. A BCD 5. A BCD 6. A B C D <br /> k SPECIAL <br /> STUDIES LOCALSTATE <br /> USE -- - - — — — — —— — — ..._. - - _._. ———— — — —— <br /> i <br /> HAZMAT IDENTIFICATION SOURCES HAZMAT CASUALTIES <br /> PERSONNEL REFERENCE MATERIAL #OF #OF *OF <br /> J 40 On-Site Nan-Fire 98 No Reference DECONTAMINATED INJURIES FATALITIES <br /> RESPONDING 0 0 0 <br /> Services <br /> Material Used AGENCY PERSONNEL <br /> OTHERS 0 0 0 <br /> itVEHICLE MAKFIYFAR IVERICLE LICENSE NO.ISTATF IVEHICLE ID NO-{VIN) I CA/DOTIPUCIICC NO.I COMPANY NAME <br /> K N/A <br /> L REPORTING OFFICER NAMFJID NO.(PRINT OR TYPE) DATE COMMENTS ATTACHED <br /> Fj M Parissi, OESS 4!2!2001 <br /> �f <br /> f-'1 <br />