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401" SAN JOAQUIN COUNTY <br /> 'j ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 E. Hazelton Ave., Stockton • CA 95205 <br /> ; p. (209) 468-3420 • Fax:(209)468-3433 • Web:www.sjgov,org/ehd <br /> lFb N <br /> EMERGENCY RESPONSE RECORD <br /> DATE: 04/03/2017 SHORT TERM#. C000430200 <br /> PREMISE ADDRESS! 1990 PIOCOII Road CITY: Stockton <br /> DBA:Unified Grocers Inc. CR05S STREET: HWY 99 <br /> PREMISE OWNER:UNlfled Grocers Inc. PHONE: 209-470-1922 <br /> OWNER•SADDRE55:5200 Sheila St. [Iry;Commerce <br /> FACILITY CONTACT!Thelma Sass PHONE:209470-1922 <br /> RESPONSIBLE PARTY(RP)DBA:Unlfled Grocers Inc. <br /> RP NAM E:Unlfled Grocers Inc. 01-IONE:209-470"1922 <br /> RP ADDRE55: 1990 PICCOII Road CITY;Stockton <br /> RP CONTACT.Thelma Sass PHONE:209-470-1922 <br /> NATURE OF RESPONSE(explosion,spill,leak,fire,or abandoned/dumped material) <br /> Forklift operator was moving a pallet of bleach from an upper level and due to unknown reason it fell onto <br /> the ground and spilled approximately 180 gallons of Bleach. <br /> TIME RECEIVED:08:30 am TIME OF ARRIVAL: 1.30pm TIME OF DEPARTURE:03.27pm <br /> PERSONS AT SCENE <br /> NAME AGENCY PHONE TOA TOD <br /> Haza Saeed SJC EHD 209-953-6212 0830 am 03:27pm <br /> MATERIAL/CLAS51FICATION(cusMiuuuvamao) <br /> IDENTIFICATION SPILLED? SOLID LIOUID GAS [OMMENTS <br /> (LBS) (GAL) (NRI <br /> Bleach XY D N 168 Approximated amount <br /> o ON <br /> 0Y ON <br /> o ON <br /> o ON <br /> 0Y ON <br /> REFERRALS AND NOTIFICATIONS <br /> REFERRED TO(NAME AND ADDRESS) DATE MAILED <br /> DATE PROP 65 COMPLETED: 04/04/2017 DATE UAR COMPLETED: <br /> IF PERSONS EXPOSED and/or INJURED,"PERSONAL TOXICSUBSTANCE EXPOSURE RECORD"COMPLETED? 0 YES 0 NO <br /> ER BINDER COPIES: <br /> X SHORT-TERM ON TOP X NARRATIVE X MAP 0 ANALYTICAL DATA 0 PROP 65/UAR 0 FILE CREATED <br /> X MANIFEST 0 REFERRALS 0 CLEANUP REPORT X OTHER AGENCY REPORTS 0 EXPOSURE RECORD X PHOTOS <br /> ER RECORD Page 1 10/03/12 <br />