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,..•_� .,, SAN 70AQUIN 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:8/1/2016 SHORTTERMN: C00041974 <br /> PREMISE ADDRESS:Jack Tone Rd. CITY.Stockton <br /> DBA:NA CROSS STREET:Mariposa Rd. <br /> PREMISE OWNER:NA PHONE: NA <br /> OWNER'S ADDRESS:NA - CITY: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 /> Report of 50 bags of unknown solid in roadway. <br /> TIME RECEIVED: 1600 TIME OF ARRIVAL: 1630 TIME OF DEPARTURE: 1700 <br /> PERSONS AT SCENE <br /> NAME AGENCY PHONE TOA TOD <br /> Jamie Lima SJC EHD (209) 953-6211 1630 1700 <br /> MATERIAL/CLASSIFICATION(�EMIOUwvaVED) <br /> IDENTIFICATIONSOLID LIQUID <br /> GAS SPILLED? COMMENTS <br /> (LBS) (GAL) ICU FTI <br /> clay p(Y u N 250 5-50 pound bags <br /> o u <br /> o o <br /> 0Y ON <br /> 0Y ON <br /> 0Y ON <br /> REFERRALS AND NOTIFICATIONS <br /> REFERRED TO(NAME AND ADDRESSI DATE MAILED <br /> DATE PROP 65 COMPLETED: DATE JAR COMPLETED: <br /> IF PERSONS EXPOSED and/or INJURED,"PERSONAL TOXIC SUBSTANCE EXPOSURE RECORD"COMPLETED? ❑ YES ❑ NO <br /> R BINDER PIES: <br /> )Q SHORT-TERM ON TOP X NARRATIVE X MAP 1 0 ANALYTICAL DATA i O PROP 65/UAR ❑ FILE CREATED <br /> 0 MANIFEST 0 REFERRALS 0 CLEANUP REPORT 1 0 OTHER AGENCY REPORTS 1 0 EXPOSURE RECORD ❑ PHOTOS <br /> ER RECORD Page 1 10/03/12 <br />