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07/02/2010 FRI 15:53 FAX 2094683433 SJC EHD 9001 <br /> *** FAX TX REPORT *** <br /> TRANSMISSION OK <br /> JOB NO. 3504 <br /> DESTINATION ADDRESS 98382474 <br /> PSWD/SUBADDRESS <br /> DESTINATION ID <br /> ST. TIME 07/02 14:42 <br /> USAGE T 70' 04 <br /> PGS. 25 <br /> RESULT OIC <br /> SAN TOA UIN COUNTY <br /> o.•,.,,: •• c Q <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> N:[�1 4� <br /> 600 E Main Street Stockton ■ CA 95202 <br /> r> °' (209) 468•-3420 • Fax: (209) 464--0138 • Web: www.sjgov.org/ehd <br /> EMERGENCY RESPONSE RECORD <br /> DATE: ZO SHORT TERM#: 0000 <br /> PREMISE CITY: <br /> ADDRESS: <br /> DBA: <br /> PREMISE OWNER: PHONE: <br /> OWNER'S ADDRESS: S - CITY: <br /> FACILITY CONTACT: PHONE: <br /> DBANSIBLE PARTY (RP) <br /> RP PHONE: <br /> NAME: r+np,-. <br /> RP ADDRESS: CITY: <br /> RP CONTACT: 3 die%►- ��2�, PHONE: 19 <br /> NATURE OF COMPLAINT(explosion,spill,leak, fire,or abandoned/dumped material) <br /> pp 7.06 k 4wt 4► ayP cwt CQ,� s-s�+e g r�c�. u <br /> TIME II TIME OF TIME OF DEPARTURE: <br /> RECEIVED: l ARRIVAL: 7r:3a � y 0 <br /> PERSONS AT SCENE <br /> NAME //__ AGENCY PHONE TOA TOD <br /> A- <br /> I <br /> IDENTIFICATION OF MATERIAL cc"rmFcAL rrwoamw <br /> SUBSTANCE FORM SOLID POWDER GAS LIQUID GRANULE <br /> REFERRALS TO: DATE MAILED: <br /> DATE COMPLETED....PROP 65: / UAR: <br /> nrnnr,�ro rvnnarn__�i__,wrnrrn _ ' <br />