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San Joaquin County <br />Environmental Health Department <br />600 East Main Street <br />DIRECTOR <br />Donna Heran, REHS <br />ASSISTANT DIRECTOR <br />Laurie Cotulla, REHS <br />Stockton, California 95202-3029 <br />PROGRAM COORDINATORS <br />Carl Borgman, REHS <br />Website: www.sjgov.org/ehd <br />Phone: (209) 468-3420 <br />Mike Huggins, REHS, RDI <br />Margaret Lagorio, REHS <br />Robert McClellon, REHS <br />Fax: (209) 464-0138 <br />,teff Carruesco, REHS, RDI <br />EMERGENCY RESPONSE RECORD <br />Kasey Foley, REHS <br />DATE: �? 161 a SHORT TERM #: C U DD3 3 OJ <br />PREMISEDAD RESS: 3. ^�' 3 N 1��y1 ��' CITY: �C � O(, �10►� <br />.{- <br />DBA: Iegba o V"a�� LU. <br />PREMISE OWNER: PHONE: <br />OWNER'S <br />FACILITY CONTACT: PHONE: <br />RESPONSIBLE PARTY (RP) DBA: 1e S D I'Lb W Q( lid �" 612., /� <br />RP NAME: k - 1 PHONE: (LA) g bb- p D Uy <br />RP ADDRESS: q LSI) ? 1�' " br. • � gZ �p4--j_ <br />RP CONTACT: <br />NATURE OF COMPLAINT (explosion, spill, leak, fire, or abandoned/dumped material) <br />PHONE: <br />TIME RECEIVED: U D TIME OF ARRIVAL: Z TIME OF DEPARTURE: 2 <br />PERSONS AT SCENE <br />NAME AGENCY PHONE TOA TOD <br />-161,Iso w,0146% or L) _Lei) Lf1P_6-9i#v <br />pkLjl is2vit vt - I <br />IDENTIFICATION OF MATERIAL (ctEnmcu. INVOLVED) () ey t r VelL <br />SUBSTANCE FORM ❑ SOLID [jPOWDER ❑ GAS LIQUID <br />REFERRALS TO: C V nn IiJ Q (/I& DA <br />DATE COMPLETED ........PROP 65: <br />PERSONS EXPOSED and/or INJURED <br />[-]GRANULE <br />MAILED: &4611t <br />NAME ADDRESS PHONE <br />"PERSONAL TOXIC SUBSTANCE EXPOSURE RECORD" COMPLETED? ❑ YESNO <br />10 <br />E. R. BINDER COPIES: <br />SHORT-TERM ON TOP <br />❑ EXPOSURE RECORD <br />`J{w REFERRALS <br />NARRATIVE ❑ ANALYTICAL DATA <br />❑ MANIFEST ❑ CLEAN UP REPORT <br />1` z MAP ❑ FILE CREATED <br />PROP 65 / UAR <br />❑ OTHER AGENCY REPORTS <br />Document I Page: I of 3 6/14/1999 <br />