Laserfiche WebLink
PUBLIC HEALTH SERVICES <br /> SAN JOAQUIN COUNTY w ii <br /> ENVIRONMENTAL HEALTH DIVISION <br /> Karen Furst, M.D., M.P.H., Health Officer • r'' • a <br /> �C/FORe� <br /> 304 East Weber Avenue,Third Floor • Stockton, CA 95202 <br /> 209/468-3420 �( <br /> EMERGENCY RESPGNSE RFCORSHORTTER Co Do I %� <br /> DATE 1-Z I IJ /bZ <br /> � CITY Vu'zl*� <br /> u <br /> PREMISE ADDRESS 1 10 s S <br /> DBA �GV /� An <br /> PHONE <br /> PREMISE OW NER •�TJ�Gn^us �t1#3f P r�l�''"'` �4 �a� g v(4 3 <br /> T <br /> OWNER'S ADDRESS -! C XJrV po)NW+ f vCi <br /> CA PHONE <br /> FACILITY CONTACT 9�f B + <br /> RESPONSIBLE PARTY(RP)DBA F3 `Q <br /> P rol2VM PHONE <br /> RP NAME <br /> RP ADDRESS PHONE ,s&5 jo3- 49'5U <br /> RPCONTACT l^rF <br /> NATURE OF COMPLAINT(explosion, spill, leak, fire,r abandoned/dumped mate) d t q 9 H d4-,e- <br /> A- <br /> µ� <br /> Z 1tjN�/„s <br /> �„ ,t_ rorn A/l, rrtT n v>✓ d r✓�trM f nr,� /�nnp✓�� •2l1 <br /> OA <br /> 0 <br /> 'f �',OD ATIME OF ARRIVAL l�L!SM TIME OF DEPARTURE � '3 pM <br /> TIME RECEIVED (O g35a- <br /> PERSONS AT SCENE PHONE C)CS'TOA TOD <br /> NAME AGENCY SI(I°SP' <br /> s� Id'tS ^ 4:DD <br /> tJicdl¢. pRVI°S QcQ� t� t♦r�pp <br /> pp,tS D � vQQtV - r- 6 ff4h""-- <br /> .�zs (2Soar^ <br /> MAA 31 rir,�S ` SSrrop� <br /> 4 � <br /> l�n�s0 InA- up/1 <br /> IDENTIFICATION OF MATERIAL ccs w MoLvM) ❑ GAS LIQUID ❑ GRANRr 4ULE , <br /> REFERRALS TO L�1" �l A�' <br /> SUBSTANCE FORM 11 SOLID . ❑ POWDE.Rd- 6 <br /> PW 1 i L NVv4 j DATE MAILED 1'"�DUn UAR <br /> DATE COMPLETED........PROP 65 <br /> PERSONS EXPOSED and/or INJURED 1 0151 HONE D <br /> NAME ADDRESS lST L �fn55+� CA (Zen) `1 GI S <br /> — „'rol B0cANQ'�er it <br /> "PERSONAL TOXIC SUBSTANCE EXPOSURE RECORD" COMPETED? Y <br /> NO <br /> E.R.BINDER COPIES: NARRATIVE ❑ ANALYTICAL DATA [I PROP 65/UAR <br /> ❑ SHORT-TERM ON TOP ❑ OTHER AGENCY REPORTS <br /> ❑ EXPOSURE RECORD ❑ MANIFEST 0 CLEAN ATEDORT <br /> ❑ REFERRALS ❑ MAP <br /> 6/14/1999 <br /> A Division of San Joaquin Coun y Health Care Services - <br /> ......�..•n�e.. Anr. <br />