Laserfiche WebLink
Y <br /> S <br /> f •� <br /> �1'UBLI� HEALTH SERVICES <br /> SAN JOAQUIN COUNTY <br /> . .�•-.oma <br /> ENVIRONMENTAL HEALTH DIVISION <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 95201-0388 <br /> 2091468-3420 <br /> EMERGENCY RESPONSE RECORD <br /> DATE �6 '17 SHORT TERM# Cara p 7g7�l_ <br /> NBEMISE ADDRESS " '/ i'►iA,0 ,+l v rte: 0, Ak ke CITY 1-4,01 <br /> DBA 014k <br /> ?REMISE OWNER PHONE <br /> OWNER'S ADDRESS ! 00 ,4it404C c00 PAS' oq o) 6p <br /> FACILITY CONTACT PHONE Zf7► O <br /> RESPONSIBLE PARTY (RP) DBA ` <br /> RP NAME PHONE d <br /> RP ADDRESS v (A045 dMd&4 <br /> RP CONTACT PHONE v)q —v'A <br /> NATURE OF COMPLAINT Jexplosion. SPHL leak. fire. or a6andaaedlducrq�ed a�aoerial) t�v G <br /> TIME RECEIVED _ LZ:_C�� TIME OF ARRIVAL_=/: TIIu1E OF DEPARTURE <br /> Row) <br /> PERSONS AT SCENE (IOD) <br /> NAME <br /> dv�t1G� TOA _im <br /> L, s <br /> f - 7? <br /> 0292 1_f-CL,r4 <br /> --3odv <br /> Jq%_05v <br /> IDENTIFICATION OF MATERIAL�cuesuc�u.,Nvorareo, G/F ELS J�v�� <br /> SUBSTANCE FORM: [l SOLID [] POWDER [1-GAS (QUID [] GRANULE <br /> REFERRALS TO: DATE MAILED: <br /> DATE COMPLETED: PROP 65 s ,l!!f_Z_„ UAR <br /> PERSONS EXPOSED and/or INJURED <br /> NAME ag= PHONE NO. <br /> 'PERSONAL TOXIC SUBSTANCE EXPOSURE RECORD' COMPLETED? [] YES [] NO <br /> E. R. BINDER COPIES: <br /> SHORT-TERM ON TOP (r, ARRATIYE [I ANALYTICAL,.DATA PROP 65MAR <br /> [ EXPOSURE RECORD [ [ ] CLEAN UP REPORT /11, OTHER AGENCY REPORTS <br /> [l REFERRALS [1 FELE CREATED <br /> EH 22 614 4/96 <br /> A Division or San Joaquin County Health Care 5en•ites <br />