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Aug 28 06 02: 35p San - -aquin County OES 2094682-nO p. 7 <br /> `/ 1.00 <br /> CALIFORNIA HAZARDOUS MATERIALS INCIDENT REPORT SYSTEM <br /> A AGENCY NAME AGENCY ID NO. INCIDENT NO. AGENCY TEL NO. OES CONTROL NO. <br /> _ San Joaquin OES 3ggp7 XS7-01244 (209)468-3962/3969 Not Assigned <br /> INCIDENT DATE TIME NOTIFIED TIME COMPLETED DATE COMPLETED <br /> B 2/14(2001 1230 1530 If DIFFERENT FROM <br /> r INCIDENT DATE <br /> INCIDENT ADDRESS/LOCATION CITY/COMMUNITY COUNTY ZIP <br /> C 3901 E. Miner Stockton San Joaquin 95215 <br /> 1 <br /> WEATHER I TEMP I PROPERTY LIS I SURROUNDINQAREA IPROPERTY MANAGEMENT <br /> D 1 CLEAR 400 Residential 400 Residential Private <br /> _ RELEASE FAM. RS ITYPEOFEQUIPMENT INVOLV DMOBILEPROPERTY TYPE <br /> E 98 No Release 98 No Equip Involved 98 No Mobile Property Involved <br /> ACTIONS TAKEN <br /> F 64 Provide Public Info. <br /> CHEMICAL OR TRADE NAME DOT ID NO. DOT HAZARD CLASS CAS NO. <br /> Clandestine Drug Lab Chemicals <br /> HYSICALSTATE 1PHYSICALSTATE QUANTITY RELEASED ENVIRONMENTAL CONTAMINATION EXTELTOF <br /> STORED RELEASED RELEASE <br /> r <br /> Various <br /> CONTAINERDESCRIPTION CONTAINER TYPE LEVEL OF CONTAINER CONTAINER MATERIAL CONTAINER CAPACITY <br /> Various Various Various Various Various <br /> G CHEMICAL OR TRADE NAME DOT ID NO. DOT HAZARD CLASS CAS NO. <br /> PHYSICAL STATE PHYSICAL STATE QUANTITY RELEASED ENVB20NMENTAL CONTAMINATION EXTENT OF <br /> STORED RELEASED RELEASE <br /> CONTAINER DESCRIPTION CONTAINER TYPE LEVEL OF CONTAIN CONTAINER MATERIAL CONTAINER CAPACITY <br /> MORE THAN 2 SUBSTANCES INVOLVED? ❑YES ❑NO <br /> ADDITIONAL INFORMATION <br /> H <br /> SPECIAL <br /> 1.A BCD 2. A BCD 3. A B C D 4. A BCD 5. A R C D 6. ABCD <br /> I <br /> STUDIES LOCAL STATE <br /> USE _ - - - — —_ _ - --_ _ - - - —— - - <br /> ' HAZMAT IDENTIFICATION SOURCES HAZMAT CASUALTIES <br /> PERSONNEL REFERENCE MATERIAL #OF #OF #OF <br /> J <br /> 60 Off-Site Non-Fire 98 No Reference DECONTAMINATED INJURIES FATALITIES RESPONDING N/A N/A N/A <br /> Services Material Used AGENCY PERSONNEL <br /> OTHERS N/A /A N/A <br /> EHICLE MAKE/YEAR IVEHICLE LICENSE NO. STATE IVEHICLE ID NO.(VIN) CA/DOT/PUC/ICC NO. COMPANY NAME <br /> �. K 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 3/3/2001 YES <br /> w <br />