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HF RDOUS MATERIALS RELEASE FSORT <br /> SAN JOAQUIN COUNTY OFFICE OF EMERGENCY SEFMC o <br /> Date Reported: Time Reported:A0 Taaa <br /> JS <br /> Date of Release: O Time&Duration of Release: <br /> Reported By: ` Telephone No.: <br /> Business Name: 4 C <br /> Location/Address of Release: <br /> ; o Quantity Released: <br /> Chemical Released q,�, <br /> , <br /> Contamination _ Air Water _ Soil I _ Other Injuries(YIN) Awa <br /> Responsible Party: =phone <br /> rT' G <br /> Description of what happened: ,S'elffev,,J-0/ we, <br /> �e.d. d..•,lf.'� 6ac.k fa �^ou"�:a� IN�L /.�f o� ���✓ <br /> le A/ ., sNr�sr we., <br /> !0". !iI- H_/L •�•S Yo SL IiF /1165 atrf O�fC9 0. , <br /> Report Taken By: <br /> Additional Agencies That May Need To Be Notified: <br /> State Warning Center 800-852.7550 UC Davis Poison Control Center 800-342-9293 <br /> National Response Center 800-424-8802 RWQCB(Central Valley Region) 916-361-5199 <br /> DTSC(Region l) 916-255-3545 Cal OSHA(Modesto) 209.576-6260 <br /> Dept.of Fish&Game 916-445-0045 USCG 510-437-3073 <br /> County Env. Health <br /> 209-468-3420 USEPA(Region IX) 415-744-2000 <br /> County Ag Commissioner 209-468-3300 CHEMIPEC 800-424-9300Rev.6-4-96 <br />