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Feb 23 05 10: 28a San Paquin County OES 209468E p. 27 <br /> CALIFORNIA HAZARDOUS MATERIALS INCIDENT REPORT SYSTEM <br /> AAGENCY NAME AGENCY ID NO. INCIDENT NO. AGENCY TEL NO. OES CONTROL NO. <br /> San Joaquin OES 39807 XSJ-01069 (209)468-3962/3969 00-2353 <br /> y INCIDENT DATE I TIME NOTIFIED TIME COMPLETED DATE COMPLETED <br /> B 6/1/2000 1500 2300 If DIFFERENT FROM <br /> INCIDENT DATE <br /> INCIDENT ADDRESS/LOCATION CITY/COMMUNrTY COUNTY ZIP <br /> C Sonora Rd at Highway 4 Unincorporated San Joaquin <br /> WEATHER TEMPI PROPERTY USE I SURROUNDING AREA PROPERTY MANAGEMENT <br /> D 1 CLEAR 85 650 Agricultural 650 Agricultural Private <br /> RELEASEFACTORS ITYPE OF EQUIPMENT INVOLVEDMOBILE PROPERTY TYPE <br /> 31 Abandoned 98 No Equip Involved 98 No Mobile Property involved <br /> ACTIONS TAKEN <br /> ri I 41—Remove hazard(Neutralize);42_ID.Analysis of hazmat;47_Decon Area(Clean Up);71_Investigate <br /> CHEMICAL OR TRADE NAME DOT ID NO. DOT HAZARD CLASS CAS NO. <br /> Flammable Liquids 3 Flammable <br /> Liquids <br /> HYSICALSTATE PHYSICAL STATE I QUANTITY RE LEASED I ENVIRONMENTAL CONTAMINATION EXTENT OF <br /> TORED RELEASED RELEASE <br /> 2 Liquid None None 8 NO RELEASE <br /> CONTAINER DESCRIPTION CONTAINERTYPE ILEVEL OF CONTAINER CONTAINER MATERIAL CONTAINER CAPACITY <br /> 2.Portable 13 Can or Bottle 11 Ground Level 1 Iron,Steel,Alloys <br /> 5 Gallon <br /> CHEMICAL OR TRADE NAME DOT ID NO. DOT HAZARD CLASS CAS NO. <br /> r_ Red Phosphorus 8 Corrosive <br /> Materials <br /> PHYSICALSTATE PHYSICALSTATE QUANTITY RELEASED ENVIRONMENTAL CONTAMINATION EXTENTOF <br /> STORED RELEASED RELEASE <br /> 1 Solid None None 8 NO RELEASE <br /> CONTAINER DESCRIPTION JCONTAINIERTYPE ILEVEL OF CONTAIN CONTAINER MATERIAL CONTAINER CAPACITY <br /> 2,Portable 11 Drum I I Ground Level 4 Plastic/Fiberglass, 5 Gallon <br /> Rigid <br /> MORE THAN 2 SUBSTANCES INVOLVED? ❑YES ®NO <br /> ADDITIONAL INFORMATION <br /> .. $ Additional contaminated articles were located(Sheets,clothing and general trash items) <br /> 1.A BCD 2. A B C D 3. A R C D 4, A BCD 5. A 3 C D 6. A BCD <br /> j SPECIAL <br /> ST[IDBiS I USE STATE <br /> USE --- - _ -- _— — _- - —- -__ - -__ <br /> HAZN.AT IDENTIFICATION SOURCES HAZMAT CASUALTIES <br /> PERSONNEL REFERENCE MATERIAL #OF POF #OF <br /> J 40 On-Site Non-Fire98 No Reference DECONTAMINATED iNiURIES FATALITIES <br /> RESPONDING p QServices Material Used AGENCY PERSONNEL 0 <br /> _ OTHERS 0 0 0 <br /> VEHICLE MAKWYEAR IVEHICLE LICENSE NO.ISTATE IVEHICLE ID NO.(VIN) CA/DOT/PUC/ICC NO. COMPANY NAME <br /> N/A <br /> L REPORTING OFFICER NAME/ID NO.(PRINT OR TYPE) DATE COMMENTS ATTACHED <br /> M Parissi, OES8 6/2/2000 YES <br />