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Feb 20 07 09; 30a San Joaquin County OES 2094682600 P. 11 <br /> CALIFORNIA HAZARDOUS MATERIALS INCIDENT REPORT SYSTEM <br /> A AGENCY NAME AGENCY ID NO. INCIDENT NO. AGENCY TEL NO. DES CONTROL NO. <br /> San Joaquin OES 39807 XSJ-01136 (209)468-3962/3969 00-3725 <br /> INCIDENT DATE TIME NOTIFIED TIME COMPLETED DATE COMPLETED <br /> B 8/18/2000 1420 1835 If DIFFERENT FROM <br /> INCIDENT DATE <br /> INCIDENT ADDRESS/LOCATION CITY/COMMUNPCY COUNTY ZIP <br /> C Castle Rd and French Camp Rd Unincorporated San Joaquin <br /> WEATHER TEMP IPROPERTY USE I SURROUNDING AREA 1PROPERTY MANAGEMENT <br /> D 1 CLEAR 90 962 County/City Road 650 Agricultural County <br /> RELEASE FACTORS TYPE OF EQUIPMENT INVOLVED IMOBILE PROPERTY TYPE <br /> E 31 Abandoned 98 No Equip Involved 98 No Mobile Property Involved <br /> _ I ACTIONS TAKEN <br /> F I 4] Remove Hazard(Neutralize);42_ID/Analysis of hazmat;47_,Decon Area(Clean up); <br /> CHEMICAL OR TRADE NAME DOT ID NO. DOT HAZARD CLASS CAS NO. <br /> Contaminated Clan Lab materials <br /> HYSICAL STATE I PHYSICAL STATE QUANTITY RELEASED ENVIRONMENTAL CONTAMINATION EXTENT OF <br /> _ TORED RELEASED RELEASE <br /> CONTAINER DESCRIPTION CONTAINER TYPE LEVEL OF CONTAINER CONTAINER MATERIAL CONTAINER CAPACITY <br /> ... G CHEMICAL OR TRADE NAME DOT 1D NO. DOT HAZARD CLASS CAS NO. <br /> N/A <br /> v <br /> PHYSICAL STATE PHYSICAL STATE QUANTITY RELEASED ENVIRONMENTAL CONTAMINATION EXTENT OF <br /> STORED RELEASED RELEASE <br /> CONTAINER DESCRIPTION CONTAINER TYPE LEVEL OF CONTAIN£ CONTAINER MATERIAL CONTAINER CAPACITY <br /> r„ MORE THAN 2 SUBSTANCES INVOLVED? ❑YES ®NO <br /> ADDITIONAL INFORMATION <br /> H I Red Phosphorus contaminated trash; <br /> Iodine contaminated absorbent <br /> ` LA B C D 2. A B C D 3. A BCD 4. A R C D S. A B C D 6. A B C D <br /> FISSSTZUCDTES L <br /> LOCAL STATE <br /> USE _- - - — —— — _ - - - _ — _ _ <br /> V <br /> HAZMAT IDENTIFICATION SOURCES HAZMAT CASUALTIES <br /> PERSONNEL REFERENCE MATERIAL 4OF SOF SOF <br /> J 40 On-Site Non-Fire 98 No Reference RESPONDING DECONTAMINATED INJURIES FATALITIES <br /> Services Material Used AGENCY PERSONNEL 0 0 0 <br /> OTHERS 0 0 0 <br /> VEHICLE MAKFJYEAR IVEHICLE LICENSE NO.ISTATE IVEAICLE ID NO.(VIN) I CA/DOT/PUC/ICC NO.ICO:YI F�NY NAME <br /> i j{ I N/A <br /> L REPORTING OFFICER NAMFAD NO.(PANT OR TYPE) DATE COMMENTS ATTACHED <br /> M Parissi, OES8 8/21/2000 NO <br /> r <br />