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SAN 3OAQUIN COUNTY <br /> 2' 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 /> CiFpN <br /> EMERGENCY RESPONSE RECORD <br /> DATE: 09/29/2015 SHORTTERM#: C00040441 <br /> PREMISEADDRESS:Copperopolls RD CITY: STOCKTON <br /> OBA:NA CROSS STREET:Jack Tone RD <br /> PREMISE OWNER:NA PHONE: NA <br /> OWNER'S ADDRESS:NA CITY: <br /> NA <br /> FACILITY CONTACT:NA PHONE:NA <br /> RESPONSIBLE PARTY(RP)DBA:NA <br /> RP NAME:NA PHONE:NA <br /> RP ADDRESS:NA CITY:NA <br /> RP CONTACT:NA PHONE:NA <br /> NATURE OF RESPONSE(explosion,spill,leak,fire,or abandoned/dumped material) <br /> Abandoned Boat with trash and Miscellaneous items <br /> TIME RECEIVED:0500 TIME OF ARRIVAL:0830 TIME OF DEPARTURE: 1130 <br /> PERSONS AT SCEN E <br /> NAME AGENCY PHONE IQA 9P <br /> Robert Lopez SJC EHD (209) 953-6214 0800 1130 <br /> HAZA SAEED SJC EHD 209 953-6212 0800 1130 <br /> MATERIAL/CLASSIFICATION(MEMIC LIN aWDl <br /> IDENTIFICATIONPS ILLED7 5= LIQUID C'm COMMENTS <br /> L9S <br /> (GAL) ICU Fit <br /> Oil o Y X N 1 Taken to HHW <br /> Oily solid DY XN 50 Taken to HHW <br /> Aerosol Cans DY XN 1 Taken to HHW <br /> Latex Paint DY XN 1/4 Taken to HHW <br /> Alkaline Batteries DY XN 1/4 Taken to HHW <br /> ❑Y .N <br /> REFERRALS AND NOTIFICATIONS <br /> REFERRED TO(NAME AND ADDRES51 DATE MAILED <br /> NA NA <br /> DATE PROP 65 COMPLETED: N/A DATE JAR COMPLETED: <br /> IF PERSONS EXPOSED and/or INJURED,"PERSONAL TOXIC SUBSTANCE EXPOSURE RECORD"COMPLETED? ❑ YE5 ❑ NO <br /> ER BINDER COPIES: <br /> X SHORT-TERM ON TOP X NARRATIVE X MAP ❑ ANALYTICAL DATA ❑ PROP 65/JAR ❑ FILE CREATED <br /> D MANIFEST ❑ REFERRALS 1 ❑ CLEANUP REPORT I VLOTHER AGENCY REPORTS 1 O EXPOSURE RECORD X PHOTOS <br /> ER RECORD Page 1 10/03/12 <br />