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i <br /> 1 <br /> opaulN 'C, <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Avenue 3rd Floor Stockton ■ CA 95202-2708 <br /> 468-3420 Fax: (209) 464-0138 • Web: www.co.san- 'oa in.ca.us/ehd <br /> o , <br /> EMERGENCY RESPONSE RECORD <br /> DATE: 03/29/2007 <br /> k SHORT TERM#!: CO00260$2 <br /> PREMISE ADDRESS: 1320 N Monroe Street <br /> CITY: $tOCkt011 <br /> DBA: PI mouth Place <br /> PREMISE OWNER: Plymouth Place Inc PHONE: <br /> (562) 257-5100 x5109 <br /> OWNER'S ADDRESS: 911 North Studebaker Rd CFFY: Long Beach CA 90815 <br /> FACILITY CONTACT: <br /> Paulette Rivera PHONE; (916)501-1186 <br /> RESPONSIBLE PARTY(RP)DBA: Plymouth Place Inc <br /> RPNAME: Stewart Hartman PHONE: (562)257-5100 x5109 <br /> RP ADDRESS: 911 North Studebaker Rd CITY: Long Beach CA 90815 <br /> RP CONTACT: Stewart Hartman PHONE: (562)257-5100 x5109 <br /> NATURE OF COMPLAINT(explosion,spill,leak,fire,or abandoned/dumped material <br /> Stockton Fire Department requested EHD assistance with clearance of area they had closed off that was impacted by a chemical irritant that <br /> caused residents and staff to become ill. <br /> TIME RECEIVED: 1 4:46 pm. TIME OF ARRIVAL: 5;00 pm TIME OF DEPARTURE: 5:45 prn <br /> PERSONS AT SCENE <br /> NAME AGENCY PHONE TOA TOD <br /> phalli a Rodriguez Stockton Fire Department 937-8801 <br /> i <br /> IDENTIFICATION OF MATERIAL(MM]CAL INVOLVED) <br /> SUBSTANCE FORM SOLID POWDER X I GAS I I LIQUID I IGRANULE <br /> f <br /> REFERRALS TO: DATE MAILED: <br /> DATE COMPLETED....PROP 65: UAR: <br /> PERSONS EXPOSED and/or INJURED <br /> NAME ADDRESS PHONE <br /> "PERSONAL TOXICSUBSTANCE EXPOSURE RECORD"COMPLETED? YES NO <br /> E.R.BINDER COPIES- <br /> X SHORT-TERM ON TOP X NARRATIVE ANALYTICAL DATA PROP 65/UAR <br /> EXPOSURE RECORD MANIFEST X CLEANUP REPORT X OTHER AGENCY REPORTS 1 <br /> REFERRALS X MAP FILE CREATED <br /> h <br /> ER RECORD MODIFIED Page Iof3 02-05-2007 <br />