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PUBLIC HEALTH SERVICES <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DIVISION w .< <br /> Ernest M. Fujimoto, M. D., M.P.H., Acting Health Officer <br /> 304 E. Weber Ave., Third Floor • P. O. Box 388 • Stockton, CA 95201-038$ <br /> 2091468-3420 <br /> EMERGENCY RESPONSE RECORD <br /> DATEL `L SHORT TERM# q q0, <br /> PREMISE-ADDRESS ��7� I� �ct� CITY /fi4 <br /> DBA `-'A T X <br /> PREMISE OWNER PHONE <br /> OWNER'S ADDRESS <br /> FACILITY CONTACT PHONE <br /> RESPONSIBLE PARTY (RP) DBA 1A, <br /> RP NAME PHONE <br /> RP ADDRESS <br /> RP CONTACT PHONE — n <br /> NATURE OF COMPLAINT (explosion, spill, leak, fire, or abandon d/dumpgd material) .ell 4l� �C <br /> TIME RECEIVED TIME OF ARRIVAL_ � " TIME OF DEPARTURE t 'gyp ' <br /> (TOA) (T D) <br /> PERSONS AT SCENE <br /> NAME AGENCY PHONE NO. TOA TOD <br /> t1two/` <br /> C <br /> IDENTIFICATION OF MATERIAL icf+ micu.mrvos.vEo1 <br /> QGic� c+✓ - '?FU <br /> SUBSTANCE FORM: [ ] SOLID [] POWDER [] GAS QUID [] GRANULE <br /> REFERRALS TO: DATE MAILED: <br /> DATE COMPLETED: PROP 65 �� �l UARI�. _ <br /> PERSONS EXPOSED and/or INJURED <br /> AME ADDRESS PHONE NO. <br /> GAT%Inglstks,Inc. <br /> Stockton Operations <br /> 4547 Frontier Way <br /> T Stockton,CA 95215 <br /> A/ <br /> "PERSONAL TOXIC SUBSTANCE E --f-09 4-cs (209) 465-5847 NO <br /> Ym,A.nr Fo.H¢eg.wd Se 4c * Fax (209)465-6058 t] <br /> Pager 1-88"13-1375 <br /> E. R. BINDER COPIES: <br /> Ron Chwk <br /> [ ] SHORT-TERM ON TOP [ Transportation Manager I PROP 651UAR <br /> [ ] EXPOSURE RECORD [ I OTHER AGENCY REPORTS <br /> t] REFERRALS <br /> EH 22 014 4/96 <br /> A Division of San Joaquin County Health Care Services <br />