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Jun 27 07 10: 35a San Joaquin County OES 2094682600 p. 2 <br /> CALIFORNIA HAZARDOUS MATERIALS INCIDENT REPORT SYSTEM <br /> F, <br /> AGENCY NAMEAGENCY ID NO. INCIDENT NO. AGENCY TEL NO. STATE OES CONTROL NO <br /> ASan Joaquin OES 39807 XSJ-00930 (209)468-3962!3969 99-3966 <br /> INCIDENT DATE TIME NOTIFIED TIME COMPLETED DATE COMPLETED <br /> F1, If DIFFERENT FROM <br /> k B 9/19/1999 0914 1550 INCIDENT DATE <br /> 4 INCIDENT ADDRESS/LOCATION CITY/COMMUNITY COUNTY ZIP <br /> C Edwards Rd.7110 mi.east of Escalon-Bellota Rd, Escalon San Joaquin 95320 <br /> WEATHER I TEP I PROPERTY USE ISURPOUNDIN7,AREA PROPERTY MANA6EMENT <br /> D 1 CLEAR 962 County/City Road 650 Agricultural County <br /> F <br /> I RELEASE FACTORS ITYPE OF E UiPMENT INVOLVED MOBILE PROPERTY'TYPE <br /> E 11 Intentional Act 98 No Equip Involved 98 No Mobile Property Involved <br /> ACTIONS TAKEN <br /> F 36 Transport,42 ID Haz Mat,47 Decon Area,63 Notify Other Agency,64 Provide Public Info. <br /> CHEMICAL OR TRADE NAME DOT Ill NO. DOT HAZARD CLASS CAS NO. <br /> Drug lab related wastes <br /> PHYSICAL STATE PRYSICAL STATE QUANTITY RHLEASED ENVIRONMENTAL CONTAMINATION EXTENT OF <br /> -- TORED RELEASED RELEASE <br /> CONTAINER DESCRIPTION CON'T'AINER TYPE LEVEL OF CONTAINER CONTAINER MATERIAL CONTAINER CAPACITY <br /> G CHEMICAL OR TRADE NAME DOT ID NO. DOT HAZARD CLASS CAS NO. <br /> t Fi <br /> PHYSICALSTATE PHYSICAL STATE QUANTITY RELEASED ENVIRONMENTAL CONTAMINATION EXTENTOF <br /> i STORED RELEASED RELEASE <br /> � 1 <br /> CONTAINER DESCRIPTION CONTAIN'ER TYPE LEVEL OF CONTAINE CONTAINER MATERIAL CONTAINER CAPACITY <br /> f_-_� <br /> MORE THAN 2 SUBSTANCES INVOLVED? ❑YES ❑NO <br /> ADDITIONAL INFORMATION <br /> PH <br /> 1.A B C D 2. A B C D 3. A S C D 4. A B C D 5. A BCD 6. A B C D <br /> SPECIAL <br /> STUDIES LOCAL STATE <br /> USE - - - - — — — — — — — — — —— — — — ——— <br /> HAZMAT IDENTIFICATION SOURCES HAZMAT CASUALTIES r <br /> PERSONNEL REFERENCE MATERIAL #OF #OF #OF <br /> _ j 60 Off-Site Non-Fire 98 No Reference RESPONDING DECONTAMINATED INJURIES FATALITIES <br /> Services Material Used AGENCY PERSONNEL 0 0 0 <br /> I � OTHERS <br /> VEHICLE MAKENEAR IVEHICLE LICENSE NO.I STATE IVEHICLE ID NO. (VIN) CPJDOT/PUC/ICC NO. COMPANY NAME <br /> rI K n/a n/a n/a n/a n/a nla <br /> E I. REPORTING OFFICER NAMEAD NO.(PRINT OR TYPE) DATE COMMENTS ATTACHED <br /> .F —� R Lopez,OES7 9/20/1999 YES <br /> k <br /> I € [ <br />