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CALIFORNIA HAZARDOUS�ATERIALS INCIDENT REPORT 11fSTEM <br /> A AGENCY NAME AGENCY ID NO. INCIDENT NO, AGENCY TEL NO. DES CONTROL NO. <br /> San Joaquin OES 39807 IR-00287 (209)468-3962/3969 016289 <br /> INCIDENT DATE TIME NOTIFIED TIME COMPLETED DATE COMPLETED <br /> B 10/30/1996 1400 1645 IIfD97 R TFROM 10/31/1996 <br /> r <br /> DATE <br /> INCIDENT ADDRESS/LOCATION CITY/COMMUNITY COUNTY ZIP <br /> C 5059 E. Ardelle St Stockton San Joaquin 95215 <br /> WEATHER I TEMP I PROPERTY USESURROUNDING AREAPROPERTY MANAGEMENT <br /> D I CLEAR 55 400 Residential 400 Residential County <br /> r. RELEASE FACTORS TYPE OF E UIPMENT INVOLVEDMOBILE PROPERTY TYPE <br /> E 11 Intentional Act 98 No Equip Involved 98 No Mobile Property Involved <br /> ACTIONS TAKEN <br /> Y. <br /> F 1 42 ID/Analysis, 71 Investigate,41 Remove Hazard <br /> ` CHEMICAL OR TRADE NAME DOT ID NO. DOT HAZARD CLASS CAS NO. <br /> Waste Chlorinated Organic Solvent&Water 9189 9 N/A <br /> HYSICAL STATE PHYSICAL STATE QUANTITY RELEASED ENVIRONMENTAL CONTAMINATION EXTENT OF <br /> TORED RELEASED RELEASE <br /> 2 Liquid No Release N/A N/A 8 NO RELEASE <br /> CONTAINER DESCRIPTION CONTAINER TYPE LEVEL OF CONTAINER CONTAINER MATERL4L CONTAINER CAPACITY <br /> Portable 11 Drum 11 Ground Level 1 Iron, Steel, Alloys <br /> 55 Gallons <br /> G <br /> CHEMICAL OR TRADE NAME DOT ID NO. DOT HAZARD CLASS CAS NO. <br /> Ir <br /> PHYSICAL STATE PHYSICAL STATE I QUANTITY RELEASED ENVIRONMENTAL CONTAMINATION EXTENT OF <br /> STORED RELEASED RELEASE <br /> CONTAINER DESCRIPTION CONTAINER=EL OF CONTAINEI CONTAINER MATERIAL CONTAINER CAPACITY <br /> J <br /> MORE THAN 2 SUBSTANCES INVOLVED? ❑YES ❑NO <br /> ADDITIONAL INFORMATION <br /> r. H The 55 gallon drum contained approximately 30 gallons of the waste solvent&water mixture. <br /> l.A BCD 2. A B C D 3. A B CD 4. A B C D 5. A B C D 6. A B C D <br /> I SPECIAL <br /> STUDS LOCAL STATE <br /> USE <br /> r HAZMAT IDENTIFICATION SOURCES HAZMAT CASUALTIES <br /> PERSONNEL REFERENCE MATERIAL #OF #OF #OF <br /> J 40 On-Site Non-FireHae Ca[ DECONTAMINATED INJURIES FATALITIES <br /> Services RESPONDING 0 0 0 <br /> AGENCY PERSONNEL <br /> OTHERS 0 0 0 <br /> [VEHICLE MAKE/YEAR IVEHICLE LICENSE NO.ISTATE IVEHICLE ID NO.(VIN) CA/DOT/PUC/ICC NO. COMPANY NAME <br /> K I N/A I N/A I N/A I N/A N/A N/A <br /> ](.. IREPORTING OFFICER NAME/ID NO.(PRINT OR TYPE) DATE COMMENTS ATTACHED <br /> P Cook, OES #9 11/12/1996 Yes <br /> r <br /> r <br />