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PUB T'' HEALTH SEV-41C i S <br /> SAN JOAQUIN COUNTY '�—f' o, <br /> JOGI KHANNA M.D.,M.P.H. <br /> Hesllh Offi(er <br /> P.D. Box 2009 . (1601 East llazehon Avenue) . So(cklon,California 912(11 <br /> (209) 46fl•3400 <br /> rMEROENCY RMSPONSI! RECORD <br /> DISTRICT Ir 3 a.b un'rr•. a (! r s r p�/n/ <br /> PREMISE ADDRESS_ ) 7100 5 Hgrin Pal LaA oo CA 953 () <br /> unn E. �_ Cr,r 0 P'.. +e coM � r A3 c' <br /> PREMISEOWNFR R, C 1r� C/ Sf o{Er /et Asses UP .AFn(T <br /> ADDRESS �nl GJ c/�,. o ; u/ C,h rp 90 z 3 <br /> FACILITY CONI-ACP S-feoe..j 1`n_hctfo Dr v��io_ o Pio„gn ar- )Oq 9ss�-'fSoo <br /> NATURE OF COMPLAINT(e_Tplosiork spill,leak fire,orabandon/dumped nemesia/): Po/L u/ i�jz t� fax w <br /> P fire. '. Sm r leic�,,.++ PUac%2cCfir,.� <br /> — <br /> ' I <br /> 'I1ME RFCEIVEO- E 3a q/,.( TIME Of ARRIVAL / / ; /O A" IIMF OF DEPARTURE 3o�Nl_ <br /> PERSONS AT SCENE (MA) (von) <br /> NAMEAI <br /> OENCY PIIUNF NO. 0A IUD <br /> ,4allicw Ct,te� A�aNnIINa Mg�r [r�-Lc`(j,roo 1-0 a49 359 z34! <br /> Ca( M (IccCn.� 11 MNNCI •, �' E.n. �rr�,«, er <br /> Cln e4: m ec laf> ry F a 107 <br /> Inb (3p cat } S ) Crr- Pcffo+te. FSS L? ?/ <br /> c16� 3y7t, <br /> IDF.NTIFICATIONOFMAIERLAL(CIMMICALINVOLVED) PolLur�+hlNe. f'ac(w <br /> SUnS1'ANCE FORM: SOLID J J POWDE)!tT J OAS f J LIQUID f f ORANULF <br /> swoi(o_ <br /> REFERRALS TO: UA'I'f! h1AlLl!O: <br /> DA1E COMPLETED: PROP 65 — UAR— <br /> PERSONS EXPOSED and/or INJURED <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> 1 <br /> INVESTIOATION REPORT(IQV.W.D <br /> (NUDEFINDINGS,CP,AEODMMENDATIONS and MAP): <br /> / <br /> m MN1C'�l Q 1(2SNU 11"6" M ch' -c C�A(!.(, <br /> b cctnr,c clr:arie`/ Cc, fil• recon o'l' � f v/ s-�r7u/ �� .< R !' �p Sa <br /> nF' 05,.fi' <br /> /J ice -Ik fire -h,r( / n-i ff• oo -i.(,P rx 1 war a 'r <br /> FILE CRPAWD J J MAP INCLUDED C1 SIIORT-11IRM A'I'1'A('l1ED 0411'� lilt 1•lLR(Y)PY Jl,r/ <br /> `� A Diritinn of San Ioago1n County I Inl(h Cate Srrriren <br />