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oPQ�°N so SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 E. Hazelton Ave., Stockton • CA 95205 <br /> POR (209)468-3420 • Fax: (209)468-3433 •Web: www.sigov.org/ehd <br /> C/ N <br /> EMERGENCY RESPONSE RECORD <br /> DATE:May 20,2016 SHORT TERM#:000041574 <br /> PREMISE ADDRES5:25705 Patterson Pass Road CITY:Tracy <br /> DBA: Shell CROSS STREET:I-580 <br /> PREMISE O W NER: PHONE: <br /> OWNER'SADDRESS: CITY: <br /> FACIUTYCONTACr: PHONE: <br /> RESPONSIBLE PARTY(RP)DBA: Shell <br /> RP NAME:Dave Harder PHONE:(661)979-5271 <br /> RP ADDRESS:25705 Patterson Pass Road CITY:Tracy <br /> RP CONTACT:Dave Harder PHONE:(661)979-5271 <br /> NATURE OF RESPONSE(explosion,spill,leak,fi e,or abandoned/dumped material) <br /> Leak of crude oil from underground piping <br /> TIME RECEIVED:3:00am TIME OF ARRIVAL:6:40am TIME OF DEPARTURE:8:10am <br /> PERSONS AT SCENE <br /> NAME AGENCY PHONE TOA TOD <br /> Dave Harder Shell onsite onsite <br /> Multiple employees Ponder Environmental <br /> Multiple employees Patriot Environmental <br /> MATERIAL/CLASSIFICATIONICHEEaxa li OLADI <br /> IDENTIFICATION SPILLED7 Soup IlIQUI � COMMENTS <br /> Crude Oil ®Y ON ❑ ® ❑ <br /> OY ON ❑ ❑ ❑ <br /> ❑Y ON ❑ ❑ ❑ <br /> OY ON ❑ ❑ ❑ <br /> OY ON ❑ ❑ ❑ <br /> JOY ON I ❑ 1 ❑ <br /> REFERRALSAND NOTIFICATIONS <br /> REFERRED TO(NAME AND ADDRESS) DATE MAILED <br /> RWQCB <br /> DATE PROP 65 COMPLETED:May 20,2016 DATE UAR COMPLETED: <br /> IF PERSONS EXPOSED and/or INJ U RED,"PERSONAL TOXIC SUBSTANCE EXPOSURE RECORD"COMPLETED? ❑YES ®NO <br /> ER BINDER COPIES: <br /> ®SHORT-TERMONTOP ISNARRATIVE IMMAP !OANALYTICAL DATA IZPROP 65/UAR OFILECREATED <br /> ❑MANIFEST JZREFERRALS 10CLEAN UP REPORT ICIOTHERAGENCY REPORTS ILJEXPOSURE RECORD ®PHOTOS <br /> ER RECORD Page 1 10/03/12 <br />