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Feb 20 07 09: 28a San Joaquin CountB OES 2094682600 <br /> CALIFORNIA HAZARDOUS MATERIALS INCIDENT REPORT SYSTEM <br /> ` tAGENCYME AGENCY ID NO. INCIDENT NO. AGENCY TEL NO. OES CONTROL NO. <br /> uin OES 39807 XSJ-01618 (209)468-3962/3969 Not Assigned <br /> ATE TIME NOTIFIED TIME COMPLETED DATE COMPLETED <br /> ` 1033 1112 uD FFERENT FROM <br /> INCIDENT DATE <br /> DDRESS/LOCATION CITY/COMMUNITY COUNTY ZIP <br /> alker Ln.0.2 mile S.of Main St. Unincorporated San Joaquin 95215 <br /> �. <br /> WEATHER I TEMP PROPERTY USE SIiRRO11NDING AREA I PROPERTY MANAGEMENT <br /> D I CLEAR 75 962 County/City Road 650 Agricultural County <br /> ►. RELEASE FACTORSTYPE OF FOUIPMFNT INVOLVEDMOBILEPR PFRTY TYPE <br /> D' 31 Abandoned 98 No Equip Involved 98 No Mobile Property Involved <br /> ` I ACTIONS TAKEN <br /> ri 97 Haz Mat Response,Material Determined To Be Non-Hazardous <br /> CHEMICAL OR TRADE NAME DOT ID NO. DOT HAZARD CLASS CAS NO. <br /> Solidified Concrete N/A N/A NIA <br /> HYSICALSTATE PHYSICALSTATE QUANTITY RELEASED JENVIRONMENTAL CONTAMINATION EXTENTOF <br /> RED RELEASED RELEASE <br /> I Solid N( RELEASE NO RELEASE None 8 NO RELEASE <br /> CONTAMER DESCRIPTION CONTAINER TYPE LEVEL OF CONTAINS CONTAINER MATERIAL CONTAINER CAPACIT <br /> 2 Portable 11 Drum 11 Ground Level 4 Plastic/Fiberglass, <br /> Rigid 5 Gallon <br /> G CHEMICAL OR TRADE NAME DOT ID NO. DOT HAZARD CLAI CAS NO. <br /> Y.v <br /> PHYSICAL STATE PHYSICAL STATE QUANTITY RELEASED ENVIRONMENTAL CONTAMINATION EXTENT OF <br /> STORED RELEASED RELEASE <br /> CONTAINER DESCRIPTION CONTAINER TYPE LEVEL OF CONTAINS CONTAINER MATERIAL CONTAINER CAPACIT <br /> f <br /> � MORE THAN 2 SUBSTANCES INVOLVED? [I YES ®NO <br /> ADDITIONAL INFORMATION <br /> i <br /> H <br /> L <br /> SPECIAL I.A B C D 2. A B C D 3. A B C D I4. A R C D 5. A B C D 6. A B C D <br /> I <br /> STUDIES LOCAL STATE <br /> USE ___ — — —_ — ___— --_ <br /> HAZMAT IDENTIFICATION SOURCES IHAZMAT CASUALTIES <br /> PERSONNELREFERENCE MATERIAL #OF #OF #OF <br /> ` J 40 On-Site Non-Fire Haz Cat DECONTAMINATED INJURIES FATALITIES <br /> RESPONDING 0 0 0 <br /> Services AGENCY PERSONNEL <br /> OTHERS 0 0 0 <br /> EHICLE MAKE/YEAR VEHICLE LICENSE NO.ISTATE IVEHICLE ID NO. (VIN) I CA/DOT/PUC/ICC NO.I COMPANY NAME <br /> -" g NIA I NIA I N/A N/A N/A I N/A <br /> REPORTING OFFICER NAME/ID NO.(PRINT OR TYPE) DATE COMMENTS ATTACHED <br /> I. <br /> P Cook, OES9 5/14/2002 NO <br />