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YoPguJN.c <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 E. Hazelton Ave., Stockton • CA 95205 <br /> (209) 468-3420 • Fax:(209)468-3433 • Web: <br /> 9L,FORN P <br /> wwwsjgov.org/ehd <br /> DATE- 8/11/15 EMERGENCY RESPONSE RECORD <br /> PREMISE ADDRESS:Tracy High School SHORTTERM#: COOO40176 <br /> DBA: CITY:Tracy <br /> PREMISE OWNER: CROSS STREET: <br /> OWNER'S ADDRESS: PHONE: <br /> FACILITY CONTACT: CITY:Tracy <br /> RESPONSIBLE PARTY(RP)DBA: PHONE: <br /> RP NAnyE:Tracy High School <br /> RP ADDRESS: PHONE: <br /> RP CONTACT: CITY:Tracy <br /> NATURE OF RESPONSE(explosion,spill,leak,fire,or abandoned/dumped material) PHONE: <br /> Radiator Coolant spilled from a car and a small amount went into the storm drain. <br /> TIME RECEIVED: TIME OF ARRIVAL: <br /> PERSONS AT SCENE TIME OF DEPARTURE: <br /> NAME <br /> Muniappa Naidu AGENCY PHONESJC EHD LOA TOD <br /> (209) 468-3439 <br /> MATERIAL/CLASSIFICATION Lasx..wwLvml <br /> IDENTIFICATION SPILLED? SOLID LI ID GAS <br /> ILI) (GAL) (CLI Ff) COMMENTS <br /> SLY ON X <br /> 0Y ON <br /> 0Y ON <br /> 11 ON <br /> 0Y o <br /> OY ON <br /> REFERRALS AND NOTIFICATIONS <br /> REFERRED TO(NAME AND ADDRESS) <br /> DATE MAILED <br /> DATE PROP 65 COMPLETED: <br /> DATE UAR COMPLETED: <br /> IF PERSONS EXPOSED and/or INJURED,"PERSONAL TOXIC SUBSTANCE EXPOSURE RECORD"COM PI ETED7 <br /> ER BINDER COPIES: 0 YES 0 NO <br /> O SHORT-TERM ON TOP 0 NARRATIVE 0 MAP <br /> ❑ ANALYTICAL DATA ❑ PROP 66/UAR 0 FILE CREATED <br /> ❑ MANIFEST O REFERRALS 0 CLEAN UP REPORT O OTHER AGENCY REPORTS 0 EXPOSURE RECORD O PHOTOS <br /> ER RECORD <br /> Page 1 10/03/12 <br />