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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.sigov.org/ehd <br /> EMERGENCY RESPONSE RECORD <br /> DATE: 12/1/2014 SHORTTERMil: C00038925 <br /> PREMISE ADDRESS: Harney Ln. CITY: Lodi <br /> DBA:NA CROSS STREET:Davis 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 /> 4-1 GALLON PAINT CANS ABANDONED ON ROADSIDE <br /> TIME RECEIVED:0915 TIME OF ARRIVAL: 1 000 TIME OF DEPARTURE: 1 330 <br /> PERSONS AT SCENE <br /> NAME AGENCY PHONE TOA TOD <br /> Jamie DeLaRosa SJC EHD (209) 953-6211 <br /> MATERIAL/CLASSIFICATION(CHEMICAL INVOLVED) <br /> IDENTIFICATION SPILLED? SOLID LIQUID GAS COMMENTS <br /> (LBS) IGAL) (CU FT) <br /> Latex paint o Y X N 4 <br /> DY ON <br /> o ON <br /> o o <br /> o eN <br /> DY ❑N <br /> REFERRALS AND NOTIFICATIONS <br /> REFERRED TO(NAME AND ADDRESS) DATE MAILED <br /> NA <br /> DATE PROP 65 COMPLETED: DATE UAR COMPLETED: <br /> IF PERSONS EXPOSED and/or INJURED,"PERSONAL TOXIC SUBSTANCE EXPOSURE RECORD"COMPLETED? D YES D NO <br /> ER BINDER COPIES: <br /> X SHORT-TERM ON TOP=X X MAP D ANALYTICAL DATA D PROP 65/LIAR FILE CREATED <br /> ❑ MANIFEST C REFERRALS D CLEAN UP REPORT D OTHER AGENCY REPORTS ❑ EXPOSURE RECORD PHOTOS <br /> FR RFCnRr) Paee 1 10/03/12 <br />