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San Joaquin County D)RECTOR <br /> Donna I--Ieran, ,REHS <br /> r-nvironinental Health Dempartment <br /> �C?�fl <br /> 600 East <br /> n Street <br /> Mal, Laurie Cotulla.REFIS <br /> X <br /> N Stockton, California 95202-3029 <br /> PROGRAM COORDINATORS <br /> Ca,-1 Borgman, REI-IS <br /> Wabsita:www.sjgov.org1ehd &fter-luggins, RENS, RDI<�l/ <br /> j'1�60 vi iVi@rgarst Lagorio, REVIS <br /> Phone: (209)468-3420 Robert McClellon,FREFIS <br /> ,Fax: (209)464-0138 Jeti'Carruesco,RENS,RDI <br /> EMERGENCY RESPONSE RECORD Kasey Foley, REI-IS <br /> DATE: it) 11141,9(6 SHORT TERM#: C oo 0�Z- <br /> PREMISE ADDRESS:_1 1)(Lo 6 CITY: L rd <br /> DBA: Cup R-K jr-< r-c <br /> PREMISE OWNER:'- P�a� 1"A I PHONE: <br /> OWNER'S ADDRESS: <br /> S,q — <br /> FACILITY CONTACT: (A It H PHONE: <br /> RESPONSIBLE PARTY(RP)DBA: &2-NkA A 4 LAn45L G V\J49E r <br /> RP NAME: &4UX5rV— 0,e� PHONE: <br /> RPADDRESS: alb-U, seiva4r 0 ju,� #-z- 14 C4 9,f6 9 <br /> RP CONTACT: PHONE: <br /> NATURE OF COMPLAINT(explosion, spill, leak, fire, or abandoned/dumped material) <br /> 04;0 15 Of P11'\ t)'Y :C !�t� � <br /> I - -Y <br /> 12,0 ely V,-Q�T S"o�I I U <br /> TIME RECEIVED: TIME OF ARRIVAL: 12 TIME OF DEPARTURE: <br /> PERSONS AT SCENE <br /> NAME AGENCY PHONE TOA TOD <br /> C L)-ZW4 bl\z, <br /> IDENTIFICATION OF MATERIAL(CHENUCAL INVOLVED) <br /> SUBSTANCE FORM ❑SOLID ❑ POWDER ❑ GAS LIQUID []GRANULE <br /> REFERRALS TO: DATE MAILED: <br /> DATE COMPLETED........PROP 65: -1b UAR: <br /> PERSONS EXPOSED and/or INJURED <br /> NAME ADDRESS PHONE <br /> "PERSONAL TOXIC SUBSTANCE EXPOSURE RECORD" COMPLETED? ❑ YES NO <br /> E. R. BINDER COPIES: <br /> 'gSHORT-TERM ON TOP �%NARRATIVE ❑ ANALYTICAL DATA PROP 65/UAR <br /> [aEXPOSURE RECORD MANIFEST ❑ CLEAN UP REPORT OTHER AGENCY REPORTS <br /> ❑ REFERRALS MAP ❑ FILE CREATED <br /> Document]. Page: 1 of3 6/14/1999 <br />