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PUXIC HEALTH SIORVICES �OP�'U1~••.0 <br /> SAN JOAQUIN COUNTY <br /> JOGI KHANNA M.D.,M.P.H. A ` <br /> Health Officer <br /> P.O. Box 2009 . (1601 East Hazelton Avenue) . Stockton,California 95201 o9L'FoP <br /> (209) 468.3400 <br /> EMERGENCY RESPONSE RECORD <br /> 1-k-17-90 <br /> DISTRICT # JA I <br /> DATE ST# <br /> PREMISE ADDRESS IIS 3 ZtJ, S/ YG/� eLCL <br /> DBA dA�� <br /> PREMISE OWNER <br /> ADDRESS _�_ <br /> FACILITY CONTACT �c1�LPmol/IEZ�/lJrAq <br /> NATURE OF COMPLAINT(explosi n,spill,len fi'e oraban on/dmnpedrnaterial) Dieg-e— <br /> a <br /> COMPLAINANT.y_ _ AGENCY PHONE NOCS-' a"75$p <br /> TIME RECEIVED I b: LS TIME OF ARRIVAL I I ) 00 TIME OF DEPARTURE So <br /> (7'0.1) (TOD) <br /> PERSONS AT SCENE <br /> NAME AGENCY PHONE NO. TOA TOD <br /> s <br /> IDEN'I1FiCATION OF MATERIAL (CIIEMICALINvotvED) <br /> gad <br /> SUBSTANCE FORM:: [ ] SOLID <br /> n 7[ ] POWDER `(,J GAS LIQUID ( ] GRANULE <br /> REFERRALS TO: ei �C 6, z)6 /7-S TSC/D DATE MAILED: <br /> DATE COMPLETED: PROP 65 /L 17- 9 UAR IV14 <br /> PERSONS EXPOSED and/or INJURED <br /> NAME ADDRESS PHONE NO. <br /> INVES -IGATIO REPORT(INCLUDE FINDINGS,QFAN-UP,RECOMMEN IIONS..d FNP): 0 Ze %I <br /> NU IXD <br /> D <br /> Gv <br /> PE.P_CRPA'I'Fl) [] MAP INCLUDED [V SHORT-IT.RM ATI-ACIlED [j,}/ ER PILE CONY [(Y <br /> A Division of San Joaquin County Health Care Services <br />