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Oct 12 09 10240a San Joaquin C 2099536268 p.3 <br /> n <br /> s~ �'£•• SAN JOAQUIN COUNTY -OFFICE OF EMERGENCY SER`IICES <br /> HAZARDOUS MATERIALS RESPONSE PROGRAM <br /> 2101 E.Earhart Avenue,Suite 300,Stockton,CA 95206 <br /> Telephone(209)953-6200 <br /> ADDENDUM TO <br /> CALIFORNIA HAZARDOUS MATERIALS INCIDENT REPORT <br /> to Incident Occured trimIncident Dau At Scene Time At Seem OI S Incident No. <br /> red <br /> 611!2000 1600 611110011 XSJ-01070 <br /> Initial Inforaration Reported Wind SpeeNDireetion <br /> Abandoned Clan Lab materials <br /> eporting Party Name Address Telephone No. <br /> Connie Hailey 25474 E Highway 4 209-885-5321 <br /> Farmington FD Farmington,CA 95230 <br /> possible Party Name Address Telephone No. <br /> N Unknown <br /> esponsible Party Representative Name Address alephone No. <br /> Unknown <br /> HaxMat Team DES Personnel On Seem <br /> titivated <br /> YES Parisi,Lopez <br /> Joint Team Activated? e�ime Activated Members On Scene <br /> p NO <br /> Fire District MitigationfRemoval Actions <br /> 04 Farmington Material removed by DISC contractor <br /> Agency Notifications and/or Referrals <br /> are oI Agency Date or Notification rune of Notification Name or Representative <br /> Notified <br /> Env.Health 6/1100 1640 Harlan Knoll <br /> Dept,of Fish and Game 611.100 1705 Brian Moore <br /> P <br /> OES Warning Center 611100 1645 Danelle Langford <br /> D'I'SC 611100 1720 Chris Marxen <br /> lReportingOfficor Signature CtiA4IR plod? ncident'rype <br /> Q Yes Abandoned Material , <br /> Page 2 <br />