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SAN JOAQUIN COUNTY <br /> 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 /> EMERGENCY RESPONSE RECORD <br /> DATE: Friday, November 7, 2014 SHORTTERM#: C00038852 <br /> PREMISE ADDRESS:Jack Tone Road CITY: Unincorporated <br /> DBA: CROSS STREET: French Camp Road <br /> PREMISE OWNER:N/A PHONE: <br /> OWNER'S ADDRESS: CITY: <br /> FACILITY CONTACT: PHONE: <br /> RESPONSIBLE PARTY(RP)DBA:NIA <br /> RP NAME: PHONE: <br /> RP ADDRESS: CITY: <br /> RP CONTACT: PHONE: <br /> NATURE OF RESPONSE(explosion,spill,leak,fire,or abandoned/dumped material) <br /> Abandoned butane cylinders <br /> TIME RECEIVED: 1.15 PM TIME OF ARRIVAL: 1.50 PMTIME OF DEPARTURE: 2.45 PM <br /> PERSONS AT SCENE <br /> NAME AGENCY PHONE TOA TOD <br /> Michael Parissi SJC EHD 953-6213 1:50 PM 2:45 PM <br /> MATERIAL/CLASSIFICATION(CHEMICAL INVOLVED) <br /> IDENTIFICATION SPILLED? SOLID LIQUID GAS COMMENTS <br /> (LBS) (GAL) (CU FT) <br /> Empty ❑Y X N All containers empty <br /> o ❑N <br /> ❑Y c <br /> ❑Y ❑N <br /> ❑Y o <br /> o ❑N <br /> REFERRALS AND NOTIFICATIONS <br /> REFERRED TO(NAME AND ADDRESS) DATE MAILED <br /> DATE PROP 65 COMPLETED: I DATE LIAR COMPLETED: <br /> IF PERSONS EXPOSED and/or INJURED,"PERSONAL TOXICSUBSTANCE EXPOSURE RECORD"COMPLETED? n YES o NO <br /> ER BINDER COPIES: <br /> )g` SHORT-TERM ON TOP )gj NARRATIVE X MAP ❑ ANALYTICAL DATA ❑ PROP 65/LIAR ❑ FILE CREATED <br /> ❑ MANIFEST c REFERRALS ❑ CLEAN UP REPORT ❑ OTHER AGENCY REPORTS ❑ EXPOSURE RECORD X PHOTOS <br /> ER RECORD Page 1 10/03/12 <br />