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SAN JOAQUIN COUNTY <br /> Z' ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 E. Hazelton Ave., Stockton • CA 95205 <br /> (209) 468-3420 • Fax;(209)468-3433 - Web.www.sjgov.org/ehd <br /> EMERGENCY RESPONSE RECORD <br /> DATE: 08/24/17 SHORT TERM#: <br /> PREMISE ADDRESS: 16888 McKinley Ave. CITY: Lathrop <br /> DBA:Super Store Industries CROSS STREET:W Louise Ave. <br /> PREMISE OWNER:Super Store Industries PHONE: 559-410-2020 <br /> OWNER'S ADDRESS:16888 McKinley Ave. CITY:Mountain House <br /> FACILITY CONTACT:Kelley R. Durrer PHONE:559-410-2020 <br /> RESPONSIBLE PARTY(RP)DBA:Super Store Industries <br /> RP NAME:Super Store Industries PHONE:559-410-2020 <br /> RP ADDRESS: 16888 McKinley Ave. CIN:Lathrop <br /> RP CONTACT:Kelley R. Durrer PHONE:559-410-2020 <br /> NATURE OF RESPONSE(explosion,spill,leak,fire,or abandoned/dumped material) <br /> Punctured fuel tank. <br /> TIME RECEIVED:12.05pm TIME OF ARRIVAL: 1.50pm TIME OF DEPARTURE:3.00pm <br /> PERSONS AT SCENE <br /> NAME AGENCY PHONE TOA TOD <br /> Aaron Hang SJC EHD <br /> <br /> <br /> UNKN UNKN <br /> MATERIAL/CLASSIFICATION(CMEMICALINVOLVED) <br /> IDENTIFICATION SPILLED? SOLID UQUID 9A COMMENTS <br /> (LBS) (GAL) ICU FT) <br /> Diesel X ❑N —10 Approximately 10 gal diesel spilled <br /> u o <br /> ❑Y c <br /> o c <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> REFERRALS AND NOTIFICATIONS <br /> REFERRED TO(NAME AND ADDRESS) DATE MAILED <br /> DATE PROP 65 COMPLETED: 8/24/17 DATE UAR COMPLETED: N/A <br /> IF PERSONS EXPOSED and/or INJURED,"PERSONAL TOXIC SUBSTANCE EXPOSURE RECORD"COMPLETED? ❑ YES n NO <br /> ER BINDER COPIES: <br /> ❑ SHORT-TERM ON TOP X NARRATIVE ,'s( MAP ❑ ANALYTICAL DATA X PROP 65/UAR X FILE CREATED <br /> J6( MANIFEST ❑ REFERRALS 1 ❑ CLEANUP REPORT ❑ OTHER AGENCY REPORTS ❑ EXPOSURE RECORD I X PHOTOS <br /> ER RECORD Page 1 10/03/12 <br />