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PUBLIC I TEALTH SERVICES <br /> SAN JOAQUIN COUNTY <br /> JOGI KHANNA M.D.,M.P.H. 1 ` <br /> Health Officer C-1 1 r <br /> CO. Bax 2009 : (1601 Eest Hnxeluan Avenue) , Stockton, Calilarnin 952111 Fo <br /> (209) 468-3400 <br /> EMPRGPI4CY RPSPONSP. RRCORU / <br /> DISTR(cr 2 U DA'Ir•. 0"_ I �sr <br /> PREMISE.ADDRESS <br /> DEA /1 L ani>Ar/ / <br /> PREMISE OWNER /vl , Z- Zn/C- <br /> ADDRESS //Z 5 S 4 cZ ti O G4 <br /> PACILIIIY CONl'ACT DAP P-y ! <br /> NATURE OF COMPLAINT(explosion;spill,leak Lre,orabandon/dumped material): ILL =J U R 1 �11(t-1+0,w 2_ FFR \ b0 AL4r- f A ' <br /> c"A-b o .v eoi57�- Si�2. �F SA2/LMIne 'D ST 7b 7 <br /> 11ME RECEIVED/U OP ARRIVAL 77ME UE DEPAR'ftlltli <br /> (70A) <br /> PERSONS AT SCENE <br /> NAME AGENCY PHONE NU. IUA TUI) <br /> LIPiKF fzI�rn— Ho t ��/_ �I-7� — <br /> C-1 f}2fG5 I.JA2dS `M 1 (Z �\C P12oD MSI if <br /> , z I,ao 'r.o <br /> '.c• S.•iis-rte v c"f-•' i� �/•' Y-.?�zcr <br /> T <br /> IDENTIFICAT10N OFMATERIAL(aIEMIGLMVOINT.0) 9o-L -» ar ,)•.-mak. GNr6hnrUt d �tc l A^ Ztw� . <br /> SUBSTANCE FORM: PSI SOLID I J POWDER I J'(IAS (eJ LIQUID ( I GRA 1)1.14 <br /> REFERRALS TO: DATE MAILED: <br /> DATE COMPLETED: PROP 6.5 UAR <br /> PERSONS EXPOSED and/or INJURED <br /> NAME ADDRESS IIIONE NO. <br /> INVESIIQATIONREPORT(wcw)eruimcs,cum.Or,mommENDATioNsendMAP): ✓ f�h�p�OVPES �� /U <br /> I'AG it Gd UA 44 � a -�r <br /> Vn6 w a l b;� plc I SZIO �olcJirs 1 <br /> .J o <br /> o A pal, <br /> 1.71,E CRP-AI77D I J MAP INCLUDED (j SIIORT-•IERM A'ITAC7IED I J HR 191.E COPY I I <br /> A Mvkion of San Joaquin Cnunry I Irallh Gtr Service% �'" <br />