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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> N 1868 E. Hazelton Ave., Stockton • CA 95205 <br /> c w <br /> (209) 468-3420 • Fax:(209) 468-3433 • Web:www.sigov.org/ehd <br /> EMERGENCY RESPONSE RECORD <br /> DATE: <br /> 10/12/2015 SHORTTERM#: C0040500 <br /> PREMISE ADDRESS: 1820 PenneBaker Way j CITY: Manteca <br /> DBA:NA CROSS STREET:Pestana Ave <br /> PREMISE OWNER:NA PHONE: NA <br /> OWNER'S ADDRESS:NA OTY:NA <br /> FACILITY CONTACT:NA PHONE:NA <br /> 9PRT <br /> (RPI DBA:GBS & EleCtrlOal CompanGas & Electrical Co. (PG&E)S MIIIS Ave, STEM Steele PHONE:(209) 337-8902 <br /> NATURE OF RESPONSE(explosion,spill,leak,fire,or abandoned/dumped material) <br /> Approximately 15 gallons spill of Mineral Oil <br /> TIME RECEIVED: <br /> 0845 TIME OF ARRIVAL: 1 O3O TIME OF DEPARTURE: 11 OO <br /> PERSONS AT SCENE <br /> NAME AGENCY PHONE Q <br /> TOD <br /> Muniappa Naidu SJC EHD (209) 468-439 1030 1100 <br /> Haza Saeed SJC EHD (209) 953-6212 1030 1100 <br /> MATERIAL/CLASSIFICATION IO2MIMINV DI <br /> IDENTIFICATION SPILLED? SOLID Q CU COMMENTS <br /> LBS GAL ICU FT <br /> Transformer Oil x(Y o N 15 PG&E cleaned up Ethespill <br /> o ❑N <br /> o ❑N <br /> o ❑N <br /> OY ❑N <br /> o ON <br /> REFERRALS AND NOTIFICATIONS <br /> REFERRED TO(NAME AND ADDRE551 DATE MAILED <br /> DATE PROP 65 COMPLETED: Yes DATE JAR COMPLETED: <br /> IF PERSONS EXPOSED and/or INJURED,"PERSONAL TOXIC SUBSTANCE EXPOSURE RECORD"COMPLETED? ❑ YES ❑ NO <br /> I R <br /> 1r( SHORT-TERM ON TOP X NARRATIVE AI MAP X ANALYTICAL DATA X PROP 65/UAR ❑ FILE CREATED <br /> JEt MANIFEST ❑ REFERRALS 1 ❑ CLEAN UP REPORT ❑ OTHER AGENCY REPORTS O EXPOSURE RECORD X PHOTOS <br /> ER RECORD Page 1 10/03/12 <br /> ER RECORD Page 2 <br /> 10/03/12 <br />