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Oct 12 09 10- 41a San Joaquin C 2099536268 p. 4 <br /> CALIFORNIA HAZARDOUt�S'1�MATERIALS INCIDENT REPORT SYSTEM <br /> A AGENCY NAME AGENCY IDNO. INC <br /> IDENT NO. AGENCY TEL NO. ATE OES CONTROL NO <br /> San Joaquin OES 39807 XSJ-01077 (209).953-6200 22-2620 <br /> CIDENT DATE TIME NOTIFIED rmEcomFEFEDADATE COMPLETED <br /> 6J 1412p00 0947 17301II13xI FROM <br /> CIDENT BATT; <br /> INCIDENT ADDRES&t.00ATTON CITY/COMMUNITY <br /> COUNTY ZIP <br /> C Gawne Rd. I mi.west of Escalon Bellota Rd. Unincorporated San Joaquin 95215 <br /> TEMP PRO USE ]SURROUNDING RIA r&QMM MANAGEMENT <br /> D 1 CLEAR 100+ 650 Agriculturai 650 Agricultural Private <br /> RELEASE FACTORS F.OF EaL9PMLW_INVO TY TYPE <br /> E 31 Abandoned 98 No Equip Involved98 No Mobile Property Involved <br /> NS TAKEN <br /> F 41_.Aemove Hazard,42 ID Haz Mat,63 Notify Other Agency,64-provide public info. <br /> CHEMICAL OR TRADE NAME ID NO. HAZARB CLASS CAS NO. <br /> 12Q Waste Phosphorous Amorphous rTjN 1338 4 Flammable <br /> Solids <br /> YSICAL STATE PHYSICAL STATEUANTITY RELEASED ENVIRONMENTAL CONTAMINATION NT OF <br /> ORED RELIJASED SE <br /> I Sol id rApprox,2 Lbs 3 Ground 9 See Comment <br /> (211quid <br /> NER DESCRIPTION AINER TYPE dTs[ OF CONTAINER CONTAINER MATERIAL [NTAINER CAPACITY <br /> 98 NO <br /> CONTAINER <br /> CAL OR TRADE NAME DOT ID NO, HAZARD CLASS CAS NO. <br /> Flammable liquid ,N.O.S.(Alcohol 1993 3 Flammable <br /> Liquids <br /> ALSTATF- PHYSICAL STATE QUANT7TYRlIRASED ENVIRONMENTAL CONTAMINATION OF <br /> R15LE ASW SE <br /> 8 NO RELEASE <br /> NER DESCRIPTION CONTALNER TYPE VEVEL OF CONTAINER CONTAINER MATI RTAL QN IA[IYF.It CAPACI T Y <br /> 13 Can or Bottle l 1 Ground Level 1 Iron,Steel,Allays 5 Gallons <br /> MORE THAN 2 SUBSTANCES INVOLVED? BYES ©NO <br /> ADDITIONAL INFORMATION <br /> H 45 gallon cans of RQ Waste Flammable Liquid,Corrosive,N.O.S.(Alcohol,Sodium Hydroxide)and 6x55 gallon <br /> drums of Non-RCRA Hazardous Waste Solid(contaminated Iab trash). <br /> 1.A B C D, 2. A BCD 3. A B C D 4. A B C D 5, A S C D 6" A B C D <br /> SPECIAL <br /> STUDIES LOCAL STATE <br /> USE — ——— _.._ _..._-- - —— —_ ———— <br /> - -- ———— <br /> HAZM. AT IDENTIFICATION SOURCES KAZMAT CASUALTIES <br /> PERSONNEL REFERENCEMATERIAL #OF #OF. #OF <br /> 60 Off-Site NOR-Fm 38 No Reference DECONTAMINATED INAMES NATALITIES <br /> RESPONDING NIA NIA NIA <br /> Services Material Used AGENCY PERSONNEL <br /> N/A N/A NIA <br /> OTHERS <br /> EHICLE MAKEtYEAR IVKJMLE LICENSE NO. ATE IVEHICLE 10 NO. W) I CAIDOTIPUC/rCC NO,I COMPANY NAME <br /> IK I NIA N/A NIA NIA NIA NIA <br /> LER <br /> RTING OFFICER NAMLI/ID NO.(PRINT OR TYPE) DATE COMMENTS ATTACHED <br /> Lopez,OFS'7 6/15/2000 YES <br /> S <br />