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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 �y <br /> DATE: Friday, January 24, 2014 SHORTTERM#: J 7 �' <br /> PREMISE ADDRESS: Harney Lane <br /> // 16 g J CITY: Lodi <br /> DBA: ✓ `rCROSS STREET: 1/4 ml east of Atkins <br /> PREMISE OWNER: ,4 r f�'-A+ ) 6,re, �1 ` _ �J PHONE: <br /> OWNER'S ADDRESS: pl't 1 lT:2"22 0 N +4wj Lt 'I () CITY: <br /> FACILITY CONTACT: PHONE: <br /> RESPONSIBLE PARTY(RP)DBA:PG&E <br /> RP NAME:PG&E PHONE:736-6426 <br /> RP ADDRESS: 1108 Murphys Grade Road CITY:Angels Camp <br /> RP CONTACT:Alex Steele PHONE:337-8902 <br /> NATURE OF RESPONSE(explosion,spill,leak,fire,or abandoned/dumped material) <br /> Hydraulic fluid spilled from broken line on PG&E equipment. <br /> TIME RECEIVED: 1 2.30pm TIME OF ARRIVAL: TIME OF DEPARTURE: <br /> PERSONS AT SCENE <br /> NAME AGENCY PHONE TOA TOD <br /> Jeffrey Wong SJC EHD (209) 468-0335 Z PAA <br /> -I ao1 <br /> MATERIAL/CLASSIFICATION(CHEMICALNVOLVED) <br /> IDENTIFICATION SPILLED? SOLID LIQUID GAS COMMENTS <br /> ff (LBS) (GAL) (CU FTI <br /> Y i d ii ❑N <br /> o ❑N <br /> ❑Y o <br /> o ❑N <br /> c ❑N <br /> L <br /> ❑Y ❑N <br /> REFERRALS AND NOTIFICATIONS <br /> REFERRED TO(NAME AND ADDRESS) DATE MAILED <br /> DATE PROP 65 COMPLETED: 4 / DATE UAR COMPLETED: <br /> IF PERSONS EXPOSED and/or INJURED,"PERSONAL TOXIC SUBSTANCE EXPOSURE RECORD"COMPLETED? ❑ YES ❑ NO <br /> BINDER COPIES: <br /> SHORT-TERM ON TOP RATIVE AP ❑ ANALYTICAL DATA PROP 65/UAR ❑ FILE CREATED <br /> ❑ MANIFEST ❑ REFERRALS I ❑ CLEAN UP REPORT ❑ OTHER AGENCY REPORTS I ❑ EXPOSURE RECORD HOTOS <br /> ER RECORD Page 1 % 10/03/12 <br />