CO2500760 (4) - Laserfiche WebLink

Home Browse Search

STATE OF CALIFORNIA DEPARTMENT OF CALIFORNIA HIGHWAY PATROL HAZARDOUS MATERIALS INCIDENT REPORT OESCONTROLNUMBER COLLISION REPORT CHP 407E(Rev 3-15)OPI 062 Refer to HPM 84.2 Chapter 2 256220 ®Yes NUMBER9266-2025-01140 ❑No HAZMAT CASUALTIES NO.EXPOSED/ NO. NO. CITY JUDICIAL DISTRICT PHOTOGRAPHS BY ❑NONE DECONNED INJURED KILLED Tracy Manteca R.Schmier 17123 AGENCY PERSONNEL 0 0 0 COUNTY NCIC HAZMAT PLACARDS DISPLAYED OTHERS 0 2 0 San Joaquin 9266 ❑Yes N No INCIDENT DATE(I WDD/YYYY) INCIDENT TIME TIME CALTRANS/COUNTY ROADS NOTIFIED TIME O.E.S.NOTIFIED STATE HIGHWAY RELATED 12/10/2025 0850 HOURS 0928 HOURS 0928 HOURS IN Yes ❑NO INCIDENT OCCURRED ON ❑AT INTERSECTION WITH I-205 W/B east of Grant Line Rd ❑OR MILEPOST INFORMATION GPS COORDINATES LATITUDE 38.5968420 LONGITUDE-121.490041° NAME(FIRST,MIDDLE,LAST) DRIVER'S LICENSE NUMBER STATE VEH.YEAR MAKE LICENSE NUMBER STATE Jose Luis Mota Sr. �V9101933 CA 2015 Mack WP72374 CA STREET ADDRESS VEH.YEAR MAKE LICENSE NUMBER STATE 4361 Stargazer Lane 1986 JL 4WG1545 CA CITY/STATEOP CODE VEH.YEAR MAKE LICENSE NUMBER STATE Modesto Ca,95356 1986 JL CA HOME PHONE BUSINESS PHONE CARRIER NAME (209)987-7307 (925)862-2260 Lime Guys Inc HAZMAT IDENTIFICATION SOURCES(CHECK ALL THAT APPLY) REGISTERED OWNER ❑SAME AS DRIVER ❑On-site fire services ❑Chemtrec Lime Guys Inc ❑Private info source ❑Poison Control Center OWNER'S ADDRESS ❑SAME AS DRIVER ❑Off-site fire services ❑Safety Data Sheet 248 Industrial Dr Stockton,CA 95206 ❑On-site non-fire services ❑Placards/Signs VEHICLE IDENTIFICATION NUMBER ❑Off-site non-fire services ❑Shipping papers 01 ❑Computer software ❑Emergency Response Guidebook 1 MIYPE FM0069 CA NUMBER VEHICLLEE TYPE BER DOT NUMBER ❑Chemist ❑No reference material used 0 Other 25 33 �32539 163752 CHEMICALrrRADE NAME UN DOT HAZARD QUANTITY RELEASED EXTENT OF RELEASE PHYSICAL PHYSICAL STATE NUMBER CLASS (LBS.,GAL.,ETC.) STATE STORED RELEASED Hieh Calcium Ouicklime 1910 8 100 lbs Outside vehicle Solid Solid CONTAINER TYPE CONTAINER CAPACITY(LBS.,GAL.,ETC.) CONTAINER MATERIAL LEVEL OF CONTAINER Cargo tank Aluminum/Aluminum alloys Above ground CHEMICALITRADE NAME UN DOT HAZARD QUANTITY RELEASED EXTENT OF RELEASE PHYSICAL PHYSICAL STATE NUMBER CLASS (LBS.,GAL.,ETC.) STATE STORED RELEASED CONTAINER TYPE CONTAINER CAPACITY(LBS.,GAL.,ETC.) CONTAINER MATERIAL LEVEL OF CONTAINER PROPERTY USE SURROUNDING AREA PROPERTY MANAGEMENT Freeway RELEASE FACTORS EQUIPMENT TYPE INVOLVED HAZMAT CONFIRMED Collision/Overturn No equipment involved I N Yes ❑No CITATION ISSUED OR COMPLAINT TO BE FILED PRIMARY CAUSE OF INCIDENT OTHER HAZARDOUS MATERIALS VIOLATIONS(NON-CAUSATIVE) ❑Yes ❑No ®Not determined ®Violation 22350 VC ❑Yes ®No ❑Other Code violation DID WEATHER CONTRIBUTE TO CAUSE OR SEVERITY OF INCIDENT? ❑Other cause ❑Yes N No WEATHER ELEMENTS(OUTLINE THE FOLLOWING ON A CHP 556.INCLUDE ADDITIONAL INFORMATION AS NECESSARr N Sequence of events N Evacuation details N Cleanup actions ® CHP On-scene Personnel(name,rank,ID ®Road closures ®Environmental impact ®Actions of other agencies number,function,exposure,hours) COMPLETE THE FOLLOWING N Incident Action Plan N Site Safety Plan ❑Proposition 65 Letters:County Health/County Board of Supervisors DATE AND TIME SCENE DECLARED SAFE BY WHOM(NAME,TITLE AND AGENCY) 12/10/2025 1030 Hours Mark Dufrene,District Area Maintenance Superintendent,California DOT PREPARERS NAME,RANK,AND ID NUMBER DATE REVIEWER'S NAME,RANK,AND ID NUMBER DATE R. Schmier,Sergeant, 17123 12/10/2025 Destroy Previous Editions An Internationally Accredited Agency Chp407E_0515.pdf