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Oct 12 09 10: 42a Sariaquin C 21399536268 P. 10 <br /> CALIFORNIA HAZARDOUS MATERIALS INCIDENT REPORT SYSTEM <br /> * AGENCY NAME AGENCY ID NO. JNCID&WNO. AGENCY TEL NO, STATE AES CONTROL NO. <br /> San Joaquin OES 39807 XSJ-01176 (209)953-6200 00-4$29 <br /> INCIDENT DATE TIME NOTIFIED- rECONEPLETED DATE COMPLETED <br /> B 10/18/2000 1532 2330 E DIFFERENT FROM <br /> IINCIDENT <br /> DATE <br /> INCIDEA I'ADDRESS/LOCATION CITYICOMMUNITY COUN"I`Y ZIP <br /> C Gawne Rd. 1.5 miles east of Mobley Rd. Unincorporated San Joaquin IM111 <br /> \VFATHI R I T P 5 SURRdifNbiNG AREA RdPEfiT Y MANAGEMENT <br /> D I CLEAR 80 962 County/City Road Sao Agricultural County <br /> RELEA F OR5 F UIPMENTINVOLVED 081 PROPER <br /> E 31 Abandoned 98 No F4Wp involved 98 No Mobile Property Involy7 <br /> ACTIONS TAKEN <br /> F 41 Remove Hazard,421D Haz Mat,63 Notify Other Agency,64 Provide Public Info. <br /> CHEMICAL OR TRADE NAME T ID NO. DO I HAZARD CLASS CAS NO. <br /> Lab Waste(Iodine,Red Phosphorous) <br /> SICAL STATE PHYSICAL STATE QUANTITY RELEASED JENVIRONMENTAL CONTAMINATION TENT OF <br /> GRED RELEASED E <br /> 3x55 Gal.Drums 8 N RELEASE. <br /> WAINER DESCRIPTION CONTAINER TYPE EL.OF CONTAINER CONTALNER MATEMIL NTAllNER CAPACITY <br /> CHEMICAL OR TRADE NAME T ID NO. DOT HAZARD CLASS FS NO. <br /> YSICAL STATE PHYSICAL STATE QUANTITY RELEASED ETNVIRONNtE TrAL CONTAMINATION OF . <br /> RED RELEASED E <br /> OWAINER DESCRIPTION C ONTA114ER TYPE EL OF CONI AINT=R CONTAWER MATERIAL ONTAINER CAPACITY <br /> —1 - I L E <br /> MORE THAN 2 SUBSTANCES INVOLVED? 13 YES ®NO <br /> ADDITIONAL INFORMATION <br /> H <br /> 1.A B C D Z. A B C D 3. A B C D 4, A R C D 5. A B C D 6. A B C D <br /> SPECIAL <br /> STUDIES LOCAL STATE <br /> USE —..._..-- --- ——— — —— —— --- — — — — <br /> AT IDENTIFICATION SOURCES RAZMAT CASUALTIES <br /> FPERSONNELEFERENCE tNA I WAL #OF #OF 0OF <br /> n-Site Nan-Fre 9$ ido Reference DECONTAMINATED INJURIESFATALITIES <br /> Ces Material.Used ESPO Y F 4 0 0 <br /> 0:4 PERSONNEL 0 0 <br /> OTHERS <br /> E11IC LE MAKFIYFARwcLE LICENSE ISO. ATE EHICLEa ID NO. IN) C AIDOT1PUMCC NO. COMPANY NAME <br /> K N/A <br /> L EPORTING OFFICER NAMEAD NO.(PRINT OR TYPE) DATE CONILMENTS ATTACHED <br /> R Lopez,OES7 10/19/2000 YES <br /> i <br />