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oPQ"'^'•..c SAN JOAQUIN COUNTY - OFFICE OF EMERGENCY SERVICES <br />CONTAINER TYPE <br />REVIEW <br />CONTAMINATION <br />EVACUATION <br />NA <br />QUANTITY REMAINING IN CONTAINER <br />az` za HAZARDOUS MATERIALS DIVISION <br />INJURES <br />VEHICLE(S) INVOLVED <br />222 East Weber Avenue, Room 610A, Stockton, CA 95202 <br />VEHICLE LICENSE NUMBER(S) <br />DATA ENTRY <br />e: :e <br />Telephone (209) 468-3969 <br />OgGlFpit�`P <br />SHIPPER'S NAME <br />Ds <br />HAZARDOUS MATERIALS INCIDENT REPORT <br />CARRIER'S NAME TELEPHONE # <br />t. CHEMICAL NAME <br />DATE <br />REPORT TAKEN BY <br />TIME REPORTED <br />TIME ON SCENE <br />DOT HAZARD CLASS <br />INCIDENT NUMBER <br />10/10/94 <br />J.Yoshioka <br />1330:00 <br />CONTAINER MATERIAL <br />r7AmTITYRE LEASED <br />101094 <br />REPORTING PARTY/ADDRESS <br />TELEPHONE NO. <br />Environment Health, Doug Wilson <br />2094683446 <br />INCIDENT LOCATION ADDRESS <br />CITY <br />ZIP CODE <br />500 Hospital Rd <br />French Camp <br />95231 <br />REPORTING INFORMATION <br />FIRE DISTRICT <br />Dr. Roper (Emergency Room Physician) reported five (5) people from Resident Treatment Center with <br />French Camp F.D. <br />respiratory problem. <br />WEATHER <br />RESPONSIBLE PARTY/ADDRESS <br />TELEPHONE # <br />RESPONSIBLE PARTY REPRESENTATIVE/OWNER <br />TELEPHONE # <br />INCIDENT TYPE <br />Other <br />PROPERTY INVOLVED <br />County <br />AREAIMPACTED <br />Rural, Residential <br />CONTAINER TYPE <br />CONTAINER CAPACITY <br />CONTAMINATION <br />EVACUATION <br />NA <br />QUANTITY REMAINING IN CONTAINER <br />2. CHEMICAL NAME <br />INJURES <br />VEHICLE(S) INVOLVED <br />DOT # <br />VEHICLE LICENSE NUMBER(S) <br />7VEHICLE <br />OWNER(S) <br />SHIPPER'S NAME <br />TELEPHONE # <br />CONTAINER MATERIAL <br />CARRIER'S NAME TELEPHONE # <br />t. CHEMICAL NAME <br />3. CHEMICAL NAME <br />TRADE NAME/MANUFACTURER <br />CAS # <br />DOT # <br />DOT HAZARD CLASS <br />PHYSICAL DESCRIPTION OF MATERIAL RELEASED <br />PHYSICAL DESCRIPTION OF MATERIAL RELEASED <br />IDENTIFICATION DETERMINED BY <br />CONTAINER TYPE <br />CONTAINER CAPACITY <br />CONTAINER MATERIAL <br />QUANTITY RELEASED <br />QUANTITY REMAINING IN CONTAINER <br />2. CHEMICAL NAME <br />TRADE NAME/MANUFACTURER <br />CAS # <br />DOT # <br />DOT HAZARD CLASS <br />PHYSICAL DESCRIPTION OF MATERIAL RELEASED <br />IDENTIFICATION DETERMINED BY <br />CONTAINER TYPE <br />CONTAINER CAPACITY <br />CONTAINER MATERIAL <br />QUANTITY RELEASED <br />QUANTITY REMAINING IN CONTAINER <br />3. CHEMICAL NAME <br />TRADE NAMEIMANUFACTURER <br />CAS # <br />T7;, <br />DOT HAZARD CLASS <br />PHYSICAL DESCRIPTION OF MATERIAL RELEASED <br />IDENTIFICATION DETERMINED BY <br />CONTAINER TYPE <br />CONTAINER CAPACITY <br />CONTAINER MATERIAL <br />r7AmTITYRE LEASED <br />QUANTITY REMAINING IN CONTAINER <br />Page 1 HMIR COMP REV 3/92113 <br />