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Feb 20 07 09: 24a San Joaquin County OES 2094682600 <br /> CALIFORNIA HAZARDOUS MATERIALS INCIDENT REPORT SYSTEM <br /> A AGENCY NAME AGENCY ID NO. INCIDENT NO. AGENCY TEL NO. OGS CONTROL NO. <br /> San Joaquin OES 39807 IR-OU287 (209)468-396213969 016289 <br /> INCIDENT DATE TIME NOTIFIED TIME COMPLETED DATE COMPLETED <br /> B 10/30/1996 1400 1645 If DIFFERENT FROM 10/31/1996 <br /> INCIDENT DATE <br /> INCIDENT ADDRESS/LOCATION CITY/COMMUNITY COUNTY ZIP <br /> C 5059 E. Ardelle St Stockton San Joaquin 95215 <br /> WEATHER PEMT I PROPERTY USE I SURROUNDING AREA IPROPERTY MANAGE21 <br /> D 1 CLEAR 55 400 Residential 400 Residential County <br /> RELEASE FACTU ITYPE OFEQUIPMENT INVOLVED MOBILE PROPERTY TYPE <br /> E 11 Intentional Act 98 No Equip Involved 98 No Mobile Property Involved <br /> ACTIONS TAKEN <br /> V <br /> ri 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 /> 6. TORED RELEASED RELEASE <br /> 2 Liquid No Release N/A N/A 8 NO RELEASE <br /> CONTAINER DESCRIPTION CONTAINER TYPE LEVEL OF CONTAINERCONTAINER MATERIAL CONTAINER CAPACITY <br /> I <br /> Portable 11 Drum 11 Ground Level 1 Iron,Steel,Alloys 55 Gallons <br /> G CHEMICAL OR TRADE NAME DOT ID NO. DOT HAZARD CLASS CAS NO. <br /> PHYSICALSTATE �PHYSICALSTATE QUANTITY RELEASED ENVIRONMENTAL CONTAMINATION EXTENT OF <br /> STORED RELEASED RELEASE <br /> ` CONTAINER DESCRIPTION CONTAIN TYPE ILEVELOFOONTAINE I <br /> CONTAINER MATERIAL CONTAINER CAPACITY <br /> ` MORE THAN 2 SUBSTANCES INVOLVED? ❑YES E3 NO <br /> ADDITIONAL INFORMATION <br /> H The 55 gallon drum contained approximately 30 gallons of the waste solvent&water mixture. <br /> v <br /> SPECIAL <br /> l.A BCD 2. A B C D 3. A B TD4. A BCD 5. ABCD 6. A BCD <br /> STUDIES LOCAL <br /> USE ___.— - --_ --- _ --_— —_ - - <br /> HAZMAT IDENTIFTCAT(ON SOURCES HAZMAT CASUALTIES <br /> PERSONNEL REFERENCE MATERIAL #OF #OF #OF <br /> J 40 On-Site Non-Fire Haz Cat DECONTAMINATED INJURIES FATALITIES <br /> �,• Services RESPONDING 0 0 0 <br /> AGENCY PERSONNEL <br /> OTHERS 0 0 0 <br /> [VEHICLE MAKFIYEAR VEHICLE LICENSE NO.ISTATE VEHICLE ID NO. (VIN) I CA/DOTlPUCACC NO.I COMPANY NAME <br /> K I NIA I N/A N/A I N/A I N/A NIA <br /> L IREPORTING OFFICER NAME/ID NO.(PRINT OR TYPE) DATE COMMENTS ATTACHED <br /> P Cook, OES #9 11/1?/1996 Yes <br />