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�iTulr., <br /> �; •s, SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 E. Hazelton Ave., Stockton • CA 95205 <br /> c (209) 468-3420 • Fax;(209) 468-3433 • Web:www.sjgov.org/ehd <br /> EMERGENCY RESPONSE RECORD <br /> DATE: 3/23/2015 SHORTTERM#: C00039402 <br /> PREMISE ADDRESS:CALAVERAS RIVER CITY: STOCKTON <br /> DBA:NA CROSS STREET:PACIFIC AVE <br /> PREMISE OWNER:NA PHONE: NA <br /> OWNER'S ADDRESS:NA CITY:NA <br /> FACILITY CONTACT:NA PHONE:NA <br /> RESPONSIBLE PARTY(RP)DBA:NA <br /> RP NAME:NA PHONE:NA <br /> RP ADDRESS:NA CITY:NA <br /> RP CONTACT:NA PHONE:NA <br /> NATURE OF RESPONSE(explosion,spill,leak,fire,or abandoned/dumped material) <br /> TWO 5 GALLON BUCKETS ABANDONED ON LEVEE <br /> TIME RECEIVED:9.30 AM TIME OF ARRIVAL: 10:30 AMTIME OF DEPARTURE: 12:00 PM <br /> PERSONS AT SCENE <br /> NAME AGENCY PHONE TOA TOD <br /> Jamie DeLaRosa SJC EHD (209) 953-6211 10:30 AM 12:OOPM <br /> HAZA SAEED SJC EHD 209 953-6212 10:30 AM 12:00 PM <br /> MATERIAL/CLASSIFICATION(CHEMICAL NVOLVED) <br /> IDENTIFICATION SPILLED? SOLID LIQUID GAS COMMENTS <br /> (LBS) (GAL) (CU FT) <br /> TWO 5 GALLON BUCKETS ❑Y »N 10 TAKEN TO HHW <br /> ❑Y o <br /> n u <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ,N <br /> REFERRALS AND NOTIFICATIONS <br /> REFERRED TO(NAME AND ADDRESS) DATE MAILED <br /> NA NA <br /> DATE PROP 65 COMPLETED: DATE UAR COMPLETED: <br /> IF PERSONS EXPOSED and/or INJURED,"PERSONAL TOXIC SUBSTANCE EXPOSURE RECORD"COMPLETED? -i YES ❑ NO <br /> ER BINDER COPIES: <br /> X SHORT-TERM ON TOP X NARRATIVE X MAP ❑ ANALYTICAL DATA ❑ PROP 65/LIAR ❑ FILE CREATED <br /> Li MANIFEST ❑ REFERRALS ❑ CLEAN UP REPORT I ❑ OTHER AGENCY REPORTS a EXPOSURE RECORD X PHOTOS <br /> ER RECORD Paee 1 10/03/12 <br />