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ENVIRONMENTAL HEALTH D�ki4A 4 <br /> SAN JOAQUIN COUNTY <br /> Donna K.Heran,R.E.H.S. Unit Supervisors <br /> Director 304 East Weber Avenue, Third Floor Carl Borgman,R.E.H.S. <br /> ._ Al Olsen,R.E.H.S. Stockton, California 95202-2708 Mike Huggins,R.E.H.S.,R.D.I. <br /> c-,��+L ~='r• Program Manager Douglas W.Wilson,R.E.H.S. <br /> Man <br /> Manager Telephone: (209) 468-3420 Margaret Lagorio,R.E.H.S. <br /> Program Man <br /> Laurie A.Cn R.E.H.S. Fax: (209) 464-0138 Robert McClellon,.R.E.H.S. <br /> Mark Barceilos,R.E.H.S. 1 <br /> EMERGENCY RESPONSE RECORD <br /> DATE 211 D-q— SHORT TERM# <br /> PREMISE ADDRESS_L6')11 L&�LAV n pbem ......_ CITY_i,/ j tQ 69 _ <br /> DBA -T(L �♦Vy11p{�� <br /> PREMISE OWNER PHONE <br /> OWNER'S ADDRESS <br /> FACILITY CONTACT PHONE <br /> .RESPONSIBLE PARTY(RP)DBA 12 cT ll IP(.o'f <br /> RP NAME -PHONE <br /> RP ADDRESS <br /> RP CONTACT PHONE <br /> NATURE OF COMPLAINT(explosion,spill,leak,fje,or abandoned/dumped material) S <br /> � O+ <br /> TIME RECEIVED TIME OF ARRIVAL L� WV^ TIME OF DEPARTURE_ Z, Co„�,y,,, <br /> PERSONS AT SCENE �—" <br /> NAME AGENCY PHONE TOA TOD <br /> VIA <br /> IDENTIFICATION OF MATERIAL t01MBcu NVOLVEn) <br /> SUBSTANCE FORM OLID ❑POWDER ❑GA5 <br /> LIQUID ❑ GRANUL$ <br /> REFERRALS TO <br /> DATE COMPLETED............PROP GSfaf.%-1 DATE MAILED <br /> PERSONS EXPOSED and/or INJURED UAR <br /> NAME ADDRESS <br /> AG918USINESS <br /> J R.SIMPLOT GOMPAI�+y -- -�scoTT A.RO-EMNQUIST i <br /> "PERSON4LTOXICSUBSTANCLcF_XPOSURERECORD" COMPLETEI 167i7B.How DRROfip PRODUCTION SUPERVISOR i <br /> E_R_BINDER COPIES: n; ox 198 <br /> �4LIFO C)sB 85330. t <br /> ❑ SHORT-TERM ON TOPZUS 11'=u�a-291 F.xr.62so <br /> ❑ NARRATIVE 13 ANA L �' �i (209)404-7000 <br /> 13 EXPOSURE RECORD ❑MANIFEST ❑CLEAN 1 FKX (2091658-6421 smsenqulgt�45inibu�t.ce,,, <br /> IJ REFERRALS <br /> ❑MAP "-�,=:�r^�} 'o':iii 7 AE:O�I;Ltt5!.,.,•,, <br /> fl FILE <br /> EH22014rev <br />