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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ,'i INA 20i' ; 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:Wednesday, June 24, 2015 SHORTTERMN: C00039923 <br /> PREMISEADDRESS: 17100 S. Harlan Road CITY; Lathrop <br /> DBA:Carpenter Co. CROSS STREET: <br /> PREMISE OWNER:Michael Parissi PHONE: 209-982-4800 <br /> OWNER'S ADDRESS:17100 S. Harlan Road CITY.Lathrop <br /> FACILITY CONTACT:Michael Parissi PHONE:209-982-4800 <br /> RESPONSIBLE PARTY(RP)DBA:Carpenter Co. <br /> RP NAME:Michael Parissi PHONE:209-982-4800 <br /> RP ADDRESS: 17100 S. Harlan Road CITy,Lathrop <br /> RP CONTACT:Michael Parissi PHONE:209-982-4800 <br /> NATURE OF RESPONSE(explosion,spill,leak,fire,or abandoned/dumped material) <br /> Spill of 2 gallons of adhesive onto ground may be due to faulty spray nozzle. <br /> TIME RECEIVED:11.44am TIME OF ARRIVAL: TIME OF DEPARTURE: <br /> PERSONS AT SCENE <br /> NAME AGENCY PP ONE TOA TOD <br /> Cindy Vo SJC EHD 209-468-8257 1:49PM 2:25PM <br /> Michael Parissi Carpenter Co. 209-982-4800 <br /> MATERIAL/CLASSIFICATION(CHEM26 iNY M) <br /> IDENTIFICATION SPILLED? SOLID OOUID aa.� COMMENTS <br /> (LBS) (GAL) ICU ff <br /> adhesive XY D N 2 spilled onto ground <br /> DY ❑N <br /> DY ON <br /> ❑Y ❑N <br /> DY ❑N <br /> ❑Y ❑N <br /> REFERRALS AND NOTIFICATIONS <br /> REFERRED TO(NAME AND ADDRESS I DATE MAILED <br /> DATE PROP 65 COMPLETED: DATE LIAR COMPLETED: <br /> IF PERSONS EXPOSED and/or INJURED,"PERSONAL TOX/CSUBSTANCE EXPOSURE RECORD"COMPLETED? D YES ❑ NO <br /> E BINDER COPIES: <br /> }[ SHORT-TERM ON TOP X NARRATIVE X MAP ❑ ANALYTICAL DATA X PROP 65/UAR O FILE CREATED <br /> ❑ MANIFEST ❑ REFERRALS ❑ CLEAN UP REPORT ❑ OTHER AGENCY REPORTS ❑ EXPOSURE RECORD b( PHOTOS <br /> ER RECORD Page 1 10/03/12 <br />