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Jan 12 06 04: 59F San Joaquin Count9 OES 2094652600 P• 19 <br /> CALIFORNIA HAZARDOUS MATERIALS INCIDENT REPORT SYSTEM <br /> _ A AGENCY N±OF-S <br /> AGENCY ID NO. INCIDENT NO. AGENCY TEL NO. OES CONTROL NO. <br /> San Joa39807 XSJ-01348 (209)468-3962/3969 <br /> INCIDENT NOTIFIED TIME COMPLETED D TEDIFCOMPLERENT ETED <br /> B 7/7/20011325 1333 INCIDENT DATE <br /> INCIDENT ADDRESS/LOCAT[ON CITY/COMMUNITY COUNTY ZIP <br /> C West 99 Frontage at Liberty Rd. Uniticorporated San Joaquin 95220 <br /> WEATHER TEMP PROPERTYIISE SURROUNDING AREA PROPERTY MANAGEMENT <br /> D <br /> ` RELEASE FACTORSTYPE OFE IIIPMENT INVOLVED MOBILE PROPERTY TYPE <br /> E <br /> ACTION TAKEN <br /> ri 63—Notify other agency <br /> CHEMICAL OR TRADE NAME DOT ID NO. DOT HAZARD CLASS CAS NO. <br /> Milk(Dairy Product) N/A NIA N/A <br /> YSICALSTATE PHYSICALSTATE QUANTITY RELEASED ENVIRONMENTAL CONTAMINATIONMEOF <br /> TORED RELEASED <br /> N/A N/A N/A N/A AT/A <br /> CONTAINER DESCRIPTION CONTAINER TYPE LEVEL OF CONTAINER CONTAINER MATERIAL CONTAINER CAPAC <br /> ITI <br /> N/A N/A N/A NIA N/A <br /> .s G CHEMICAL OR TRADE NAME DOT ID NO. DOT HAZARD CLASS CAS NO. <br /> PHYSICAL STATE PHYSICALSTATE QUANTITY RELEASED ENVIRONMENTAL CONTAMINATION EXTENT <br /> STORED RELEASED <br /> r <br /> CONTAINRR DES(RHMON jCONTA1NER TYPE �LEVELOFCONTAIINS CONTAINER MATERIAL CONTAINER CAPACI <br /> F <br /> SUBSTANCES INVOLVED? (]YES ®NO <br /> ISUBSTA TION <br /> A <br /> r <br /> SPECIAL <br /> I STUDIES LOCAL STATE <br /> USE _ — _— —_ _— .-- -- _ - - - <br /> HAZMAT IDENTIFICATION SOURCES IHAZMATCASUALIIw <br /> PERSONNEL REFERENCE MATERIAL NOF NOF #OF <br /> DECONTAMINATED INJURIES FATALITIES <br /> J N/A N/A JRESPONDING N/A WA WA <br /> AGENCY PERSONNEL <br /> OTHERS N/ANA WA NIA <br /> ICLE MAKE/YEAR VEHICLE LICENSE NO. STATE VEHICLE ID NO.(VIN) CA/DOT/PUC/ICC NO. COMPANY NAME <br /> r $ <br /> L REPORTING OFFICER NAME/ID NO.(PRINT OR TYPE) DATE COMMENTS ATTACHED <br /> r <br /> A Bentley.OESS 7/9/2001 NO <br /> r <br />