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ileo 07 10 05:44p. San -Joaquin C 2USS536268 p- 2 <br /> ,CALIFORNIA HAZARDOUS MATERIALS INCIDENT REPORT SYSTEM <br /> A <br /> AGENCY.NAME AGENCY ID NO. rIDENT'*D- <br /> ACsKNICY TEL NO. ATE OES CONTROL NO. <br /> Sart Joaquin CES 39807 XSJ-01576 i <br /> (209)953-6200 02-1314 <br /> NCIDENI DATErNmKED <br /> :rCowLETED <br /> Ell <br /> TECOMPLMED <br /> 319/2002 1210 1715 IFF�+IT FROM <br /> CII}IsA'T DATE <br /> INCIDENT ADDRESSILOCATION =/COAr MUNITY COUNTY ZIP <br /> C Dry Creek Rd.,1/4 mi.,nonh of Liberty Rd. Unincorporatcd San Joaquin 9S22i1 <br /> 1WEATHER ITEMP 1PROFERTYLTSEROUN AREA OPIsR NA <br /> D 1 CLEAR 962 County/City.Road 650 Agricultural County <br /> I2IsL.EASH 31 Abandorred CTOR mop <br /> FNT INVO V1rD 9ILE <br /> 9$ No Equip Involved 98 No Mobile Property Involved <br /> 1 ST <br /> F 41 Remove Hazard,42 ID 14az Mat,63 Notify Other Agency.,64 Provide Public Info, <br /> CHEMICAL OR TRADE NAM T ID NO. HAZARD CLASS CAS NO, <br /> Waste Sodium Hydroxide Solution 1824 8 Corrosive <br /> Materials <br /> YSICALSTATE PHYSICALSTATE QUANT'ITYR&LF-ASED ENVIRONMETI'ALCONTAMINATION OP <br /> RED RELEASED &i.FASE <br /> 2 Liquid 0 Undetermined <br /> CONTAINER DESCRIPTIONS NTAINER TYPE EL L7F CONTAINER CONTAINER MATERIAL NTAWER CAPACITY <br /> 2 Portable 13 Can or Bottle i I Ground Level 5 Plastic Flexible One Liter <br /> GrOR <br /> CAL OR TRADE NAME T ID NO. HAZARD CLASS CAS NO. <br /> Phosphoric Acid EQ5 8 Corrosive <br /> Materials <br /> Hy <br /> SPATE PHYSICAL STATE QUANTITY RELEASED ENVIRONMENTAL,CONTAMINATION OF <br /> RE EASED <br /> 2 Liquid0 Undetermined <br /> CONTAINER DESCRIFnON CONTAINERTYPE EL OF CONTAINER CONTAINER MATERIAL CONTAINER CAPACITY <br /> 2 Portable 13 Can or Battle i E Grund Level 5 Plastic Flexible One Gallon <br /> MORE THAN 2 SUBSTANCES INVOLVED? 0 YES ©NO <br /> F ADDLTIONAL INFORMATION <br /> H 50 pounds of Non-RCRA Hazardous waste Solid. <br /> 1.A H C D LA BCD 3. A B C-13 4. A R C D 5. A B C D 6. A B C D <br /> SPECIAL <br /> STUDIES LOCALSTATE <br /> USE — . _ —.- - - -- ——— — ———— - - <br /> HAZMAT IDENTIFICATION SOURCES HAZMAT CASUALTIES <br /> PERSONNEL REFERENCE MATERIAL 8 OF #OF $OF <br /> j W Off-Site Non-Fire 96 No Reference DECONTAMINATW WURIES FATALITIES <br /> Services" Material Used PONDING NIA NIA NIA <br /> AG PERSONNEL <br /> OTHERS NIA NIA NIA <br /> 1sHICLE MAKFJYEAR IVEHICLELICENSENO. ATE CIE ID NO.(VIN) G4dDOTIPUCIICC NO.I COMPANY NAME <br /> K N/A N/A NIA NIA N/A NIA <br /> LRTING OFFICER NAME/ID NO.(PRINT'OR TYPE) DATE COMMENTS ATTACHED <br /> R L apez,OES7 312812002 YES <br /> I <br /> i <br /> I <br /> I <br />