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Fug 28 06 02: 34p San - -aquin County OES 2094682P^0 p. 2 <br /> J <br /> CALIFORNIA HAZARDOUS MATERIALS INCIDENT REPORT SYSTEM <br /> A AGENCY NAME AGENCY ID NO. JINCIDENT NO. AGENCY TEL NO. I OES CONTROL NO. <br /> San Joaquin OES 39807 1 IR-00459 (209)468-3962/3969 <br /> INCIDENT DATE TIME NOTIFIED TIME COMPLETED DATE COMPLETED <br /> B10/11/1997 1800 1930 If DIFFERENT FROM <br /> INCIDENT DATE <br /> INCIDENT ADDRESSILOCATION CITY/COMMUNITY COUNTY ZIP <br /> C 226 S.Anteros Stockton San Joaquin <br /> WFATRER TEMPI PROPERTY(ISE I SURROUNDING AREA IPROPERTY MANAGEMENT <br /> D 1 CLEAR 65 400 Residential 400 Residential Private <br /> rI RELEASE FACTORS ITYPE OF BOUIPMFNT INVOLVEDOBILE PROPERTY TYPE <br /> E 31 Abandoned 98 No Equip Involved 98 No Mobile Property Involved <br /> ACTIONS TAKEN <br /> ri 41,Remove Hazard(Neutralize),,42,ID/Analysis of HazMat:97,HazMat response,material determined to be <br /> nonhazardous <br /> CHEMICAL OR TRADE NAME DOT ID NO. DOT HAZARD CLASS CAS NO. <br /> HYSICAL STATE PHYSICAL STATE QUANTITY RELEASED ENVIRONMENTAL CONTAMINATION EXTENT OF <br /> GRED RELEASED RELEASE <br /> CONTAINER DESCRIPTION CONTAINER TYPE LEVEL OF CONTAINE CONTAINER MATERIAL CONTAINERCAPACM <br /> Gr CHEMICAL OR TRADE NAME DOT IDNO. DOT HAZARD CLASS I CAS NO. <br /> PHYSICALSTATE 1PHYSICALSTATE QUANTITY RELEASED ENVIRONMENTAL CONTAMLNATION EXTENT OF <br /> STORED RELEASED RELEASE <br /> r CONTAINER DESCRIPTION ICONTAINERTYPE LEVEL OF CONT.47TAINER MATERIAL CONTAINER CAPACITY <br /> MORE THAN 2 SUBSTANCES INVOLVED? ❑YES ®NO <br /> ADDITIONAL INFORMATION <br /> Items were uncontaminated Clan Lab items such as funnels,plastic containers,etc. <br /> r <br /> SPECIAL I.A B C D 2. A B C D 3. A B C D 4. A B C D 5. A BCD 6. A B C D <br /> I <br /> STUDIES LOCAL STATE <br /> USE — _ — _ —— — _— — _ — _ - - _ — —_-- ____ <br /> r <br /> HAZMAT IDENTIFICATION SOURCES HAZMATCASUALTIES <br /> PERSONNEL REFERENCE MATERIAL #OF NOF ROF <br /> J 40 On-Site Non-Fire 98 No ReferencUsed eNDING DECONTAMINATED INJURIES FATALITIES <br /> Services Material AGENCY� PERSNNEL <br /> OTHERS <br /> EHICLE MAKFIYEAR IVEHICLB LICENSE NO. STATEVEHICLEIDNO.(VIN) IC.4/DOT/PUCIICCNO. COMPANY NAME <br /> K I NIA <br /> L REPORTING OFFICER NAMEPID NO.(PRINT OR TYPE) DATE COMMENTS ATTACHED <br /> r, M Parissi 10/1211997 No <br />