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Rug 28 06 02: 37p San - -aquin County OES 2094682"''0 p. 13 <br /> r <br /> CALIFORNIA HAZARDOUS MATERIALS INCIDENT REPORT SYSTEM <br /> r, A AGENCY NAME AGENCY ID NO. INCIDENT NO. AGENCY TEL NO. OES CONTROL NO. <br /> San Joaquin CES 39807 XSJ-01261 (209)468-3962/3969 01-1333 <br /> INCIDENT DATE TIME NOTIFIED TIME COMPLETED DATE COMPLETED <br /> .- B 3/52001 1430 2130 If DIFFERENT FROM <br /> INCIDENT DATE <br /> INCIDENT ADDRESSfLOCATION CITY/COMMUNITY COUNTY ZIP <br /> C 3800 Rick Ave. Stockton San Joaquin 95215 <br /> r <br /> WEATHER TEM1PI PROPERTY USE I SURROUNDING AREA IPROPERTY MANAGEMENT <br /> D 3 RAIN 962 County/City Road 400 Residential County <br /> RELEASE FACTORS ITYPE OF EOUTPIAENT INVOLVED [MOBILE PROPERTY TYPE <br /> E 98 No Release 98 No Equip Involved 98 No Mobile Property Involved <br /> _ I ACTIONS TAKEN <br /> ri 1 41 Remove Hazard,42 ID Haz Mat,63 Notify Other Agency,64 Provide Public Info. <br /> CHEMICAL OR TRADE NAME DOT ID NO. DOT HAZARD CLASS CAS NO. <br /> Waste CorrosiveLiquid,Basic,Inorganic,NOS 3266 8 Corrosive <br /> (Sodium Hvdroxidel Materials <br /> SICAL STATE PHYSICAL STATE I QUANTITY RELEASED I ENVIRONMENTAL CONTAMINATION IEXTENT OF <br /> RED RELEASED RELEASE <br /> 2 LiquDESCRIPTION <br /> 2.5 gal. 8 NO RELEASE <br /> CONTAINERPTION CONTAINER TYPE LEVEL OFCONTATNTEJ CONTAINER MATERIAL CONTAMER CAPACIT <br /> Various Various Various Various Various <br /> G CHEMICAL OR TRADE NAME DOT ID NO. DOT HAZARD CLASS CAS NO. <br /> r <br /> PHYSICAL STATE I PHYSICAL STATE QUANTITY RELEASED I ENVIRONMENTAL CONTAMINATION EXTENT OF <br /> STORED RELEASED RELEASE <br /> r CONTALNBR DESCRIPTION ICONTAINERTYPE �LEVELQFCONTAINFICONTAI;FR4ATERIAL CONTAINER CAPACITY <br /> r` MORE THAN 2 SUBSTANCES INVOLVED? ❑YES ❑NO <br /> ADDITIONAL INFORMATION <br /> r <br /> I SPECIAL <br /> STUDIES FOCAL STATE <br /> USE _ ___ _ - -- <br /> HAZMAT IDENTIFICATION SOURCES HAZMAT CASUALTIES <br /> PERSONNEL REFERENCE MATERIAL #OF #OF NOF <br /> 60 Off-Site Non-Fire Reference DECONTAMINATED INJURIES FATALITIES <br /> r ,J 98 No ReRESPONDING NIA N/A N/A <br /> Services Material Used AGENCY PERSONNEL <br /> OTHERS N/A N/A N/A <br /> [VEHICLE MAKE/YEAR IVEHICLE LICENSE NO.ISTATE IVEHICLE ID NO. (VIN) CA/DOT/PUCt1CCNO.I COMPANY NAME <br /> r g I N/A I N/A I N/A N/A N/A N/A <br /> L REPORTING OFFICER NAME/ID NO.(PRINT OR TYPE) DATE COMMENTS ATTACHED <br /> R Lopez,OES7 3/132001 YES <br />