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f <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> / 1868 E. Hazelton Ave., Stockton • CA 95205 <br /> cP (209) 468-3420 • Fax;(209) 468-3433 • WL*b.,www.sjgov.org/ehd <br /> 9C�F ORN\ <br /> EMERGENCY RESPONSE RECORD <br /> DATE: May 23, 2016 Ai s <br /> SHORT TERMq: <br /> PREMISE ADDRESS: 1990 Piccoll Rd, Stockton, CA 95215 Stockton <br /> aTv: <br /> DBA,Unified Grocers CROSS STREET:Waterloo Rd <br /> PREMISE OWNER:United Grocers, Inc PHONE: (323) 264-5200 <br /> OWNER'S ADDRESS:5200 Sheila Street, Commerce, CA 90040 Commerce <br /> CITY: <br /> FACILITY CONTACT:Thelma Sass <br /> PHONE:(209)470-1922 <br /> RESPONSIBLE PARTY(RP)DBA:United Grocers, Inc <br /> RP NAME:United Grocers, Inc PHONE: <br /> RP ADDRESS:1990 Piccoli Rd, Stockton, CA 95215CITY:Stockton <br /> RP CONTACT:Thelma Sass <br /> PHONE:(209)470-1922 <br /> NATURE OF RESPONSE(explosion,spill,leak,fire,or abandoned/dumped material) <br /> 20 gallons of household bleach spilled inside the United Grocers Warehouse. <br /> TIME RECEIVED:12.30 pm TIME OF ARRIVAL: 130 TIME OF DEPARTURE:3.00 pm <br /> PERSONS AT SCENE <br /> NAME AGENCY PHONE TOA TOD <br /> Fatinah Zareef SJC EHD (209) 953-7311 130 pm 300 pm <br /> Thelma Sass Unified Grocers (209) 470 1922 unknown unknown <br /> MATERIAL/CLASSIFICATION 0EMIC INVMVFDI <br /> IDENTIFICATION SPILLED? SOLID LIQUID <br /> (LBS) (GAL) (NRI COMMENTS <br /> Bleach X o N 20 <br /> DY o <br /> n CN <br /> DY u <br /> o o <br /> DY ON <br /> REFERRALS AND NOTIFICATIONS <br /> REFERRED TO(NAME AND ADDRESS) DATE MAILED <br /> DATE PROP 65 COMPLETED: May 23, 2016 DATE UAR COMPLETED: <br /> IF PERSONS EXPOSED and/or INJURED,"PERSONAL TOXIC SUBSTANCE EXPOSURE RECORD"COMPLETED? ❑ YES X NO <br /> ER BINDER COPIES: <br /> M SHORT-TERM ON TOP X NARRATIVE I X MAP 0 ANALYTICAL DATA 1 M PROP 65/UAR 0 FILE CREATED <br /> Tal MANIFEST 0 REFERRALS 0 CLEANUP REPORT 0 OTHER AGENCY REPORTS 0 EXPOSURE RECORD X PHOTOS <br /> ER RECORD <br /> Page 1 10/03/12 <br />