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� s , <br /> off° " SAN JOAQUIN'COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT ► <br /> 600 E Main Street Stockton•CA 95202 <br /> ' (209)468-3420•Fax.(209)464-0138 . Web:www.sjgov.ore/ehd <br /> I <br /> EMERGENCY RESPONSE RECORD <br /> DATE: June 7, 2007 SHORT TERM#: C000 � <br /> PREMISE 40E. Neuharth CITY: Lodi ' <br /> ADDRESS: i <br /> DBA: Cottage BakeryE <br /> PREMISE PHONE: <br /> OWNER: <br /> OWNER'S PO Box 1720 CITY: Lodi CA 95241 <br /> ADDRESS: <br /> FACILITY Chuck Douros PHONE: (209)810-0147 <br /> CONTACT: <br /> RESPONSIBLE PARTY (RP) Cottage Bakery <br /> DBA: <br /> RP NAME: Chuck Douros PHONE: (209) 810-0147 <br /> ADDRESS: 40 E. Neuharth Drive CITY: Lodi CA 95241 <br /> RPr <br /> CONTACT: Chuck Douros or Stacey Silva PHONE: (209) 810-0147 <br /> ) <br /> NATURE OF COMPLAINT(explosion, spill, leak, fire, or abandoned/dumped material) <br /> Fire occurred in the bread oven. <br /> i <br /> TIME 825PM TIME OF 855PM TIME OF 945PM <br /> RECEIVED: ARRIVAL: DEPARTURE: j <br /> PERSONS AT SCENE <br /> NAME AGENCY PHONE TOATOD <br /> Chuck Douros Cottage Bakery 2098100147 NA _ NA �4 <br /> } <br /> Stacey Silva Cottage Ba ery 209 810 5192 NA NA <br /> Lodi Fire NA NA <br /> IDENTIFICATION OF MATERIAL(CHEMICAL INVOLVED) <br /> SO <br /> FORM <br /> SUBSTANCE LI POWDER GAS LIQUID GRANULE <br /> D j <br /> REFERRALS DHS Food&Drug Division by phone 6/8/07 @ 10:50 AM DATE <br /> TO: MAILED: <br /> DATE COMPLETED....PROP U <br /> 65: A <br /> R I <br /> f <br /> PERSONS EXPOSED and/or INJURED 1 <br /> NAME ADDRESS PHONE ) <br /> NONE t� <br /> t <br /> I <br /> ER RECORD MODIFIED Page I of 4 05/01/2007 <br /> e <br />