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nug 28 06 02: 35p San - aquin County GES 209468?'n0 p. 4 <br /> v <br /> CALIFORNIA HAZARDOUS MATERIALS INCIDENT REPORT SYSTEM <br /> A AGENCY NAME AGENCY ID NO. INCIDENT NO. AGENCY TEL NO. OES CONTROLNO. <br /> San Joaquin OES 39807 XSJ-01556 (209)468-396?3969 02-0807 <br /> INCIDENT DATE TIME NOTIFIED TIME COMPLETED DATE COMPLETED <br /> B 2/11/2002 1229 1400 If DIFFERENT FROM <br /> INCIDENT DATE <br /> INCIDENT ADDRESS/LOC.ATION CITY/COMMUNITY COUNTY ZIP <br /> C North end of Anteros at Myrtle Stockton San Joaquin 95215 <br /> WEATHER TEMP 1PROPERTYUSE ISURROUNDTNG AREA I PROPERTY MANAGEMENT <br /> D 1 CLEAR 68 400 Residential 400 Residential City <br /> RELEASE FACTORS ITYPE OF EQUIPMENT VOLVEDM B L PROPERTY TYPE <br /> E 31 Abandoned 99 See Comment Page 99 See Comment Page <br /> ACTIONS TAKEN <br /> F 1 42-ID analysis of Hazmat;41 -Remove hazard <br /> CHEMICAL OR TRADE NAME DOT ID NO. DOT HAZARD CLASS CAS NO. <br /> Waste oil with water 1270 3 Flammable Mixture <br /> Liquids <br /> HYSICALSTATE 1PHYSICALSTATE QUANTITY RELEASED ENVIRONMENTAL CONTAMINATIONEXTENT OF <br /> r TORED RELEASED RELEASE <br /> 2 Liquid 2 Liquid <1/2 quart 3 Ground 6 Property of Origin <br /> CONTAINER DESCRIPTION CONTAINER TYPE LEVEL OF CONTAINE CONTAINER MATERIAL CONTAINER CAPACITY <br /> _ 2 Portable Bucket 11 Ground Level 4 Plastic/Fiberglass, 5 Gallons <br /> G I Rigid <br /> CHEMICAL OR TRADE NAME DOT ID NO. DOT HAZARD CLASS CAS NO. <br /> PHYSICAL STATE PHYSICAL STATE QUANTITY RELEASED ENVIRONMENTAL CONTAMINATION rONTNT OP <br /> STORED RELEASED RELEASE <br /> CONTAINER DESCRIPTION CONTAINER TYPE LEVEL OF CONTAIN CONTAINER MATERIAL rNTAfNERCAPACITY <br /> MORE THAN 2 SUBSTANCES INVOLVED? ❑YES I&NO <br /> ADDITIONAL INFORMATION <br /> H <br /> SPECIAL <br /> 1.A B C D 2. A B C D 3. A7CD4. A B C D 5. A B C D 6. A B C D <br /> STUDIES LOCAL TE <br /> USE __ _ _ <br /> r <br /> HAZMAT IDENTIFICATION SOURCES IHAZMAT CASUALTIES <br /> PERSONNEL REFERENCE MATERIAL #OF 40F #OF <br /> J 40 On-Site Non-Fire 99 See Comments DECONTAMINATED INJURIES FATALITIES <br /> �.. RESPONDING 0 0 0 <br /> Services Page AGENCY PERSONNEL <br /> OTHERS N/A N/A N/A <br /> VEHICLE MAKE/YEAR VEHICLE LICENSE NO.ISTATE IVEHICLE 1D NO.(VIN) ICA/DOT/PUC11CCNO.j COMPANY NAME <br /> r K I N/A N/A N/A I N/A I N/A I N/A <br /> L REPORTING OFFICER NAMEAD NO.(PRINT OR TYPE) DATE COMMENTS ATTACHED <br /> A Bentley,OES5 2/11/2002 YES <br /> w <br />