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SAN JOAQUIN COUNTY <br /> 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: Thursday, September 11, 2014 SHORT TERM#: C00038517 <br /> PREMISE ADDRESS:Turnpike Road CITY: Unincorporated <br /> DBA: CROSS STREET:Duck Creek <br /> PREMISE OWNER:NIA 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 containers unknown contents <br /> TIME RECEIVED:8.1 0 AM TIME OF ARRIVAL:8.30 AM TIME OF DEPARTURE:9.30 AM <br /> PERSONS AT SCENE <br /> NAME AGENCY PHONE TOA TOD <br /> Michael Parissi SJC EHD 953-6213 8:30 AM 9:30 AM <br /> MATERIAL/CLASSIFICATION(CHEMICAL INVOLVED) <br /> IDENTIFICATION SPILLED? SOLID LIQUID GAS COMMENTS <br /> (LBS) (GAL) (CU FT) <br /> Waste Latex Paint ❑Y X N 10 <br /> u o <br /> o c <br /> o c <br /> o o <br /> o o <br /> REFERRALS AND NOTIFICATIONS <br /> REFERRED TO(NAME AND ADDRESS) DATE MAILED <br /> DATE PROP 65 COMPLETED: I DATE UAR 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 ❑ ANALYTICAL DATA ❑ PROP 65/UAR ❑ FILE CREATED <br /> ❑ MANIFEST ❑ REFERRALS ❑ CLEAN UP REPORT ❑ OTHER AGENCY REPORTS ❑ EXPOSURE RECORD X PHOTOS <br /> ER RECORD Page 1 10/03/12 <br />