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STATE OF CALIkANIA <br />DEPARTMENT OF CALIFORNIA HIGHWAY PATROL <br />HALAKUL)U5 MA I EKIALS INCIDENT REPORT <br />CHP 407E (Rev. 3-15) OPI 062 Refer to HPM 84.2, Chapter 2 <br />OES CONTROL NUMBER <br />18-5480 <br />COLLISION REPORT <br />No r Yes NUMBER 9266-2018-01002 • <br />HAZMAT CASUALTIES NO. EXPOSED/ <br />DECONNED <br />NO. <br />INJURED <br />NO. <br />KILLED <br />CITY <br />Unincorporated <br />JUDICIAL DISTRICT <br />Stockton <br />PHOTOGRAPHS BY NONE I <br />AGENCY PERSONNEL <br />COUNTY <br />San Joaquin <br />NCIC <br />9266 <br />HAZMAT PLACARDS DISPLAYED <br />No OTHERS Yes <br />INCIDENT DATE (11.414VDD/YYYY) <br />08/14/2018 <br />INCIDENT TIME <br />0710 HOURS <br />TIME CALTRANS/COUNTY ROADS NOTIFIED <br />0730 HOURS <br />TIME O.E.S. NOTIFIED <br />0830 HOURS <br />STATE HIGHWAY RELATED <br />No 1 Yes • <br />INCIDENT OCCURRED ON <br />1-580 <br />. AT INTERSECTION WITH Chrisman Road East of @ OR <br />MILEPOST INFORMATION GPS COORDINATES <br />LATITUDE 37.6671000 LONGITUDE -121.449268° <br />NAME (FIRST, MIDDLE, LAST) <br />Jose Hernandez <br />DRIVER'S LICENSE NUMBER <br />A5448828 <br />STATE <br />CA <br />VEH. YEAR <br />2001 <br />MAKE <br />International <br />LICENSE NUMBER <br />9C43487 <br />STATE <br />CA <br />STREET ADDRESS <br />2174 Fox Grove Road <br />VEH. YEAR <br />1998 <br />MAKE <br />Comm 2 Axle <br />LICENSE NUMBER <br />4ND7159 <br />STATE <br />CA <br />CITY/STATE/ZIP CODE <br />Tustin, CA 92780 <br />VEH. YEAR MAKE LICENSE NUMBER STATE <br />HOME PHONE <br />(714) 206-6855 <br />BUSINESS PHONE <br />Same <br />CARRIER NAME <br />HER VAL trucking . <br />HAZMAT IDENTIFICATION SOURCES (CHECK <br />services <br />services <br />ALL THAT APPLY) <br />Control Center <br />Data Sheet <br />papers <br />Response Guidebook <br />material used <br />REGISTERED OWNER SAME AS DRIVER <br />On-site fire services Chemtrec <br />Private info source Poison OWNER'S ADDRESS "r SAME AS DRIVER <br />Off-site fire services Safety <br />On-site non-fire Placards/Signs VEHICLE IDENTIFICATION NUMBER <br />2HSCEAMROICO20554 <br />Off-site non-fire Shipping <br />Computer software Emergency ot No reference VEHICLE TYPE <br />27 131 <br />CA NUMBER <br />401942 <br />DOT NUMBER Chemist <br />M Other <br />CHEMICAL/TRADE NAME <br />Diesel fuel <br />UN <br />NUMBER <br />1993 <br />DOT HAZARD <br />CLASS <br />2.1 <br />QUANTITY RELEASED <br />(LBS., GAL., ETC.) <br />20 Gal <br />EXTENT OF RELEASE <br />Outside vehicle <br />PHYSICAL <br />STATE STORED <br />Liquid <br />PHYSICAL STATE <br />RELEASED <br />Liquid <br />CONTAINER TYPE <br />Vehicular fuel tank <br />CONTAINER CAPACITY (LBS., GAL., ETC.) <br />75 Gal <br />CONTAINER MATERIAL <br />Aluminum/Aluminum alloys <br />LEVEL OF CONTAINER <br />Above ground <br />CHEMICALJTRADE NAME UN <br />NUMBER <br />DOT HAZARD <br />CLASS <br />QUANTITY RELEASED <br />(LBS., GAL., ETC.) <br />EXTENT OF RELEASE PHYSICAL <br />STATE STORED <br />PHYSICAL STATE <br />RELEASED <br />CONTAINER TYPE CONTAINER CAPACITY (LBS., GAL., ETC.) CONTAINER MATERIAL LEVEL OF CONTAINER <br />PROPERTY USE <br />Freeway <br />SURROUNDING AREA <br />Freeway <br />PROPERTY MANAGEMENT <br />Federal <br />RELEASE FACTORS <br />Collision/Overturn <br />EQUIPMENT TYPE INVOLVED <br />Vehicle fuel system <br />HAZMAT CONFIRMED <br />Yes • No <br />CITATION ISSUED OR COMPLAINT TO BE FILED PRIMARY CAUSE OF INCIDENT <br />22350 VC <br />OTHER HAZARDOUS MATERIALS VIOLATIONS (NON-CAUSATIVE) <br />Yes No • Not determined i4 Violation Yes No <br />Other Code violation DID WEATHER CONTRIBUTE TO CAUSE OR SEVERITY OF INCIDENT? <br />WEATHER Clear Other cause M Yes'i4 No <br />ELEMENTS (OUTLINE THE FOLLOWING ON A CHID 556. INCLUDE ADDITIONAL INFORMATION AS NECESSARY) <br />El Sequence of events Z Evacuation details cleanup actions CHP On-scene Personnel (name, rank, ID <br />Z Road closures <br /> [g] Environmental impact Z Actions of other agencies <br /> number, function, exposure, hours) <br />COMPLETE THE FOLLOWING <br />El Incident Action Plan El Site Safety Plan Proposition 65 Letters: County Health/County Board of Supervisors <br />DATE AND TIME SCENE DECLARED SAFE BY WHOM (NAME, TITLE AND AGENCY) <br />08/14/2018 1500 HOURS Juan Armendarez, HAZMAT manager, CALTRANS <br />DATE PREPARER'S NAME, RANK, AND ID NUMBER <br />Sergeant Lecce, ID 15236 08/15/2018 Lieutenant Wharry, ID 14792 08/15/2018 <br />DATE REVIEWER'S NAME, RANK, AND ID NUMBER <br />Destroy Previous Editions An Internationally Accredited Agency Chp407E_0515.pdf