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PaU SAN JOAQUIN COUNTY <br /> f:. z 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:May 20,2016 SHORT TERM#:000041574 <br /> PREMISE ADDRESS:25705 Patterson Pass Road CITY:Tracy <br /> DBA: Shell CROSSSTREET:I-580 <br /> PREMISEOWNER: PHONE: <br /> OWNER'SADDRESS: CITY: <br /> FACILITY CONTACT: PHONE: <br /> RESPONSIBLE PARTY(RP)DBA: Shell <br /> RP NAME:Dave Harder PHONE:(661)979-5271 <br /> RP ADDRESS:2S70S Patterson Pass Road CITY:Tracy <br /> RP CONTACT:Dave Harder PHONE:(661)979-5271 <br /> NATURE OF RESPONSE(explosion,spill,leak,fie,or abandoned/dumped material) <br /> Leak of crude oil from underground piping <br /> TIME RECEIVED:3:00am TIME OF ARRIVAL:6:40am TIME OF DEPARTURE:8:10am <br /> PERSONS AT SCENE <br /> NAME AGENCY PHONE TOA TOD <br /> Dave Harder Shell 661 979 5271 onsite onsite <br /> Multiple employees Ponder Environmental <br /> Multiple employees Patriot Environmental <br /> M ATE R I A L/C LASS I F I CATION(CHEMICAL INVOLVEDI <br /> IDENTIFICATION SPILLED? SOLID LCUID GAS COMMENTS <br /> (LaS) (GAL) (CU FTI - <br /> Crude Oil ®Y El ❑ IM ❑ <br /> ❑Y ❑N ❑ ❑ ❑ <br /> ❑Y ❑N ❑ ❑ ❑ <br /> ❑Y ❑N ❑ ❑ ❑ <br /> ❑Y ©N ❑ ❑ ❑ <br /> ❑Y El ❑ ❑ <br /> REFERRALS AND NOTIFICATIONS <br /> REFERRED TO(NAME AND ADDRESS) DATE MAILED <br /> RWQCB <br /> DATE PROP 65 COMPLETED:May 20,2016 DATE UAR COMPLETED: <br /> IF PERSONS EXPOSED and/or INJURED,"PERSONAL TOXIC SUBSTANCE EXPOSURE RECORD"COMPLETED? ❑YES ®NO <br /> ER BINDER COPIES: <br /> MSHORT-TERM ON TOP ONARRATIVE ®MAP 10ANALYTICAL DATA ®7PROP65/UAR ❑FILE CREATED <br /> ❑MANIFEST V11REFERRALS JEICLEAN UP REPORT IDOTHERAGENCYREPORTS ❑EXPOSURE RECORD JMPHOTOS <br /> ER RECORD Page 1 10/03/12 <br />