Laserfiche WebLink
PUBLIC HEALTH <br /> . SERVICES <br /> SAN JOAQUIN COUNTY <br /> uelith officer <br /> P.O. Box 2009 . (1601 East Hazelton Avenue) Stockton, California 9520t 4�iF6A r <br /> (209) 468-3400 <br /> Er4ERGENCY RESPONSE RECORD f <br /> DA*' DM-7UCT # SHORT T=.R��i <br /> Pi EMISE ADDRESS <br /> DBA U <br /> PR:.4CSE OWN£r2 PHONE <br /> 1 <br /> 0WN'a_R'S ADDREES S J <br /> FAC�__� CONTACT �l PHONE <br /> NATURE OF COMPLAINT (�expl ion. ilL leak, fim or` bandoned/dumped material) 1 <br /> aG t ©A le - <br /> I a-c r T Lc,c rc� <br /> c�Tvl D S i 4 MAE OF A.RRNAL 0T <br /> � OF DEPART URE <br /> PtRSONS AT SC" E (trn) ( oo) <br /> NA�FE AGENCY PHONE NO. TOA TOD <br /> p z <br /> � � I <br /> I 1 l <br /> IDENMFICATION OF MATERIAL (CHEMICAL INVOLVED) U ! l � • <br /> SUBSTANCE FORIM: [ ] SOLID [ ] POWDER [ ] GAS LIQUID ( ] GRAIVZJL£ <br /> REFERRALS TO:— /Y/1� DAT::MAILRD• <br /> DATE COMPEL-T-D: PROP 65 UAR <br /> PERSONS EXPOSED and/or INJURED <br /> NAME ADDRESS PHONE NO. <br /> 'PERSONAL TOXIC SUBSTANCE EXPOSURE RECORD* COMPL`E..D? [ ] YES [ } NO <br /> F�—>�. R_B ER COPIES: . <br /> S'r1ORT-'IT:RM ATTACHED ON TOP [ ] NARRATIVE { ] ANALYTICAL DATA [ ] PROP 65/iJARJCLEANtJP MFA <br /> I I EXPOSURE RECORD [ ] MANUTESI' [ ] CLEAI`IUP FIILM REPORT [ ] OTHER AGENCY REPORTS <br /> [ I REF ERFtALS [ I MAP [ ] FI1- CREA TME <br /> A Division of San Joaquin Counry HcAth Care Services <br />