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" SAN JOAQUIN COUNTY <br /> 1 ENVIRONMENTAL HEALTH DEPARTMENT <br /> . ) 1868 E. Hazelton Ave., Stockton • CA 95205 <br /> (209) 468-3420 • Fax:(209)468-3433 • Web:www.sjgov.org/ehd <br /> c 6P/ <br /> EMERGENCY RESPONSE RECORD <br /> DATE: May 23, 2017 SHORTTERM#: CODCEJOBV <br /> PREMISE ADDRESS:6649 Embarcadero Dr, slip E24 CITY.Stockton <br /> DBA:Viilage West Marina CROSS STREET:Benjamin Holt <br /> PREMISE OWNER: Village West Marina LLC PHONE: <br /> OWNER'S ADDRESS:1520 Main St, Redwood City, CA 94063 CITY: <br /> FACILITYCONTACr:Tim Fontaine, Harbormaster PHONE:209-951-1551 <br /> RESPONSIBLE PARTY(RP(DBA:Pleasure Craft Owner <br /> RP NAME:AUstm Roberts PHONE-209-609-0013 <br /> RPADDRESS:6223 Shenandoah Place, Stockton CA 95219 CITY, <br /> RP CONTACT: PHONE: <br /> NATURE OF RESPONSE(explosion,spill,leak,fire,or abandoned/dumped material) <br /> Spill/Leak of oil from a boat. <br /> TIME RECEIVED:4.15 pm ITIME OF ARRIVAL:5pm TIME OF DEPARTURE:6 pm <br /> PERSONS AT SCENE <br /> NAME AGENCY PHONE >Q TSD_ <br /> Garrett Backus SJC EHD (209) 468-2986 <br /> Officer Jeffries F and W OSPR <br /> Tim Fontaine Harbormaster <br /> Austin Roberts boat owner <br /> MATERIAL/CLASSIFICATION laem¢uixvow[oI <br /> IDENTIFICATION SPILLED? SOLID LIQUID COMMENTS <br /> BS GA CN F <br /> Oil XY DN unknown volume <br /> 0Y ON <br /> OY ❑NXa© <br /> 0Y ON village west <br /> DY DN MARINA <br /> 0Y ❑N <br /> REFERRALS AND NOTIFICATIONS <br /> REFERRED TO(NAME AND ADDRESSI Tim Fontaine 6649 Embarcadero Drive <br /> Harbormaster Stockton,CA 95219 <br /> tim@villagewesftnarina.com P 209.951.1551 <br /> f 209.951.9352 <br /> DATE PROP 65 COMPLETED: 5-24-17 <br /> IF PERSONS EXPOSED and/or INJURED,"PERSONAL TOX/CSUBSTANCE EXPOSURERECORD"COMPLETED? 0 YES 0 NO <br /> ER BINDER COPIES: <br /> X SHORT-TERM ON TOP 0 NARRATIVE X MAP 0 ANALYTICAL DATA X PROP 65/UAR 0 FILE CREATED <br /> X MANIFEST ❑ REFERRALS ❑ CLEANUP REPORT ❑ OTHER AGENCY REPORTS ❑ EXPOSURE RECORD X PHOTOS <br /> ER RECORD Pagel 10/03/12 <br />