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SAN JOAQUIN COUNTY <br /> � i ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 E. Hazelton Ave., Stockton - CA 95205 <br /> (209)468-3420 • Fax.•(209) 468-3433 • Web.www.sjgov.org/ehd <br /> EMERGENCY RESPONSE RECORD <br /> DATE: Tuesday, September 17, 2013 000037009 <br /> SHORT TERMri: <br /> PREMISE ADDRESS: 1n front of 12751 Thornton Rd. CITY: Lodi <br /> DBA:N/A ICROSS STREET: 1-5 Frontage Rd. <br /> PREMISE OWNER:County ROW PHONE: <br /> OWNER'S ADDRESS: CITY: <br /> FACILITY CONTACT: PHONE: <br /> RESPONSIBLE PARTY(RP)DBA:NIA <br /> RP NAME: PHONE: <br /> RP ADDRESS: CITY: <br /> RP CONTACT: PHONE: <br /> NATURE OF RESPONSE(explosion,spill,leak,fire,or abandoned/dumped material) <br /> Abandoned material. <br /> TIME RECEIVED:1215 ITIME OF ARRIVAL: 1410 TIME OF DEPARTURE: 1430 <br /> PERSONS AT SCENE <br /> NAME AGENCY PHONE TOA TOD <br /> Robert Lopez SJC EHD 2099536214 1410 1430 <br /> MATERIAL/CLASSIFICATION(CHEMICAL INVOLVED: <br /> IDENTIFICATION SPILLED? SOLID LIQUID �jAS COMMENTS <br /> {LBS} (GAL) ICU FT) <br /> Waste Oil ❑y x 5 <br /> ❑Y aN <br /> D o <br /> c o <br /> InY ❑N <br /> ❑Y ❑N <br /> REFERRALS AND NOTIFICATIONS <br /> REFERRED TO(NAME AND ADDRESS) DATE MAILED <br /> DATE PROP 65 COMPLETED: j DATE LIAR COMPLETED: <br /> IF PERSONS EXPOSED and/or INJURED,"PERSONAL TOXICSUBSTANCE EXPOSURE RECORD"COMPLETED? ❑ YES ❑ NO <br /> ER BINDER COPIES: <br /> X SHORT-TERM ON TOP X NARRATIVE X MAP 0 ANALYTICAL DATA ❑ PROP 65/UAR ❑ FILE CREATED <br /> ❑ MANIFEST 0 REFERRALS ❑ CLEAN UP REPORT X OTHER AGENCY REPORTS 0 EXPOSURE RECORD PHOTOS <br /> ER RECORD Page 1 10/03/12 <br />