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SAN J O A Q U I N Environmental Health Department <br /> JUNTY- - <br /> EMERGENCY RESPONSE RECORD <br /> Date: December 12,2017 Short Term#: COAQEOCDP <br /> Premise Address: 15537 S Kelso RD City: TRACY <br /> Premise DBA: Middleton Marina Cross Streef: Lindemann Road <br /> Premise Owner: Middleton Marina Owners Phone: ..... n <br /> Mailing Address: 11 DONNA MARIA WAY ORINDA, CA Owner City: ORINDA <br /> Facility Contact: FRUDDEN,JOANNE MIDDLETON TR - Contact Phone: <br /> RP DBA: Middleton Marina <br /> Onsite RP Name: UNKNOWN Onsite RP Phone: <br /> Mailing Address: 11 DONNA MARIA WAY ORINDA, CA RP City: <br /> RP Contact: UNKNOWN Contact Phone: \ 'K\K,a.rr•Q <br /> NATURE OF RESPONSE(explosion, spill, leak,fire, or abandoned/dumped material <br /> A submerged vessel is leaking fluids into the Old River and transients are dumping randoms items in the water. <br /> Time Received: 10:25 am Time of Arrival: 11:55 am Time of Departure: 12:45 am <br /> PERSONS AT SCENE <br /> NAME AGENCY PHONE Q Q <br /> Haze Saeed SJC EHD (209)953.6212 11:55 am 12:45 am <br /> Nancy Houghton Resident (209)321-1319 <br /> MATERIAL/CLASSIFICATION chemical involved <br /> MATERIAL AMOUNT SOLID(Ibs) LIQUID(gal) GAS cu n COMMENTS <br /> ❑ ❑ ❑ <br /> ❑ ❑ ❑ <br /> REFERRALS AND NOTIFICATIONS <br /> REFERRED TO(NAME AND ADDRESSI DATE MAILED <br /> Date Prop 65 Completed: Date UAR Completed: <br /> IF PERSONS EXPOSED and/or INJURED,"PERSONAL TOXIC SUBSTANCE EXPOSURE RECORD'COMPLETED? ❑YES ❑NO <br /> Page 1 of 2 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />