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C, SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 E. Hazelton Ave., Stockton • CA 95205 <br /> (209) 468-3420 • Fax;(209) 468-3433 • Web:www.sigov.org/ehd <br /> EMERGENCY RESPONSE RECORD <br /> DATE: 9-7-2016 SHORTTERM#: C06LZHK2Z <br /> PREMISE ADDRESS: 1 501 N Jack Tone Rd CITY: Ripon <br /> DBA:PG&E CROSS STREET: <br /> PREMISE OWNER:Flying J Travel Plaza , Scott Brandau PHONE: (209) 599-4141 <br /> OWNER•SADDRESS:5508 LONAS RD KNOXVILLE, TN 37939 CIn,:KNOXVILLE <br /> FACILITY CONTACT:Scott Brandau PHONE:(209) 599-4141 <br /> RESPONSIBLE PARTY(RP)DBA: <br /> RP NAME:as above PHONE: <br /> RP ADDRESS: CITY: <br /> RP CONTACT: PHONE: <br /> NATURE OF RESPONSE(explosion,spill,leak,fire,or abandoned/dumped material) <br /> 5-10 gallons of diesel fuel spilled from a parked camper vehicle and entered into an onsite storm drain <br /> TIME RECEIVED: TIME OF ARRIVAL: TIME OF DEPARTURE: <br /> PERSONS AT SCENE <br /> NAME AGENCY PHONE TOA TOD <br /> Michelle Henry SJC EHD 209-468-3454 . <br /> Elena Manzo SJC EHD 209-953-7699 Una <br /> MATERIAL/CLASSIFICATION(CHEMICAL INVOLVED) <br /> IDENTIFICATION SPILLED? SOLID LIQUID GAS COMMENTS <br /> (LBS) (GAL) (CU FT) <br /> Diesel X ❑N 5-10 spilled fuel <br /> Absorbent ❑Y X N clean up material <br /> o c <br /> o o <br /> ❑Y o <br /> o o <br /> REFERRALS AND NOTIFICATIONS <br /> REFERRED TO(NAME AND ADDRESS) DATE MAILED <br /> DATE PROP 65 COMPLETED: 9-8-2016 DATE UAR COMPLETED: <br /> IF PERSONS EXPOSED and/or INJURED,"PERSONAL TOXICSUBSTANCEEXPOSURERECORD"COMPLETED? ❑ YES ❑ NO <br /> ER BINDER COPIES: <br /> X SHORT-TERM ON TOP X NARRATIVE MAP r❑ ANALYTICAL DATA=X PROP 65/LIAR ❑ FILE CREATED <br /> ❑ MANIFEST ❑ REFERRALS ❑ CLEAN UP REPORT ❑ OTHER AGENCY REPORTS 1 ❑ EXPOSURE RECORD X PHOTOS <br /> ER RECORD Page 1 10/03/12 <br />