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PUBLIC HEALTH SERVICES <br /> OPQUIN. ( <br /> ).•'�•IEr�'.OG <br /> SAN JOAQUIN COUNTY r. : <br /> f: <br /> JOGI KHANNA M.D.,M.P.H. <br /> Health Officer <br /> O,l/FOA N`' <br /> P.O. Box 2009 (1601 East Hazelton Avenue) Stockton,California 95201 <br /> (209)468-3400 <br /> EMEROENCY RESPONSE.RINX)RD <br /> D1s icr#_ 3a 1 DATE ST# q/(a <br /> PREMISE ADDRESS Sao �✓__ /Jeb e//,i�Sf-eck aN <br /> DBA //.v/e++ rTc6 C0n11=4/t[� o,, <br /> PREMISE OWNER (/vyd Sce, Co»t 70� '/ Do,.t s Dx9r,Lvfi rr to /4" /YS. /90- /3-S <br /> ADDRESS /3z0 /.7_ frla or ' st <br /> FACILITY CONTACT UN/a" 2 ce ' ttrjrry Tia Ovo ti , [k i Disfr d�fi as /a : Lb, <br /> NATURE OF COMPLAINT(explosion,spill,len@ fir,orabandon/dumped/malerfal)_ X wmavia Leak <br /> -matin OUP!' /teac� ���ot/,,�e ;;,, /Ptrw,pralPc/ TnOc/ efiersxas war�heesea <br /> J' <br /> COMPLAINANT DPny.vl s fe(blc AGENCY_ d. PHONE NO. 209-�/6Sr - 3969 <br /> TIME RECEIVED "- .'10,4M TIME OF ARRIVAL nM TIME OF DEPARTURE .? !° J'M <br /> (SOA) (IUD) <br /> PERSONS AT SCENE <br /> NAME AGENCY PITONE NO. TOA TOD <br /> Lern/ Tfsworf/, U,vsn,.+ S"ce. Ao9-9y9 --/23/ <br /> 08`7f, <br /> �§rLY// Je�a.� ✓. (nu Arn ///,rf7a.. ao9— Y69-3Y7'7 <br /> 1DEN'IIFICA-IION OF MATERIAL(CHEMICALINVOLVED) �mntoNfw <br /> SUBSTANCE FORM: [ J SOLID I I POWDER [41OAS I J LIQUID I I GRANULE <br /> REFERRALS TO: — DATE MAILED: <br /> DATE COMPLETED: PROP 65 — DAR <br /> PERSONS EXPOSED and/or INJURED <br /> NAME ADDRESS PHONE NO. <br /> INVESTIGATION REPORT(INCLUDE FINDINGS,CLEAN-UP.RECOMMENDA))ON.SWA(M):_i r.rrv-m <br /> / / h1 -fJc <br /> /:/o PM, Z Krrt (-'f( L«�y ffrc > K l/r/aR £vc/NPPr of Lwn� tre, <br /> t... -f/+e warP/iousC �.a R!n•4 ?X /s0.k r d/� rrr�/ <br /> /# IV f/ bs r o" rvax llelpmzpf <br /> FILE CREATED I I MAP INCLUDED [] SHORT-TERM ATTACI IED ER FILE COPY�]� <br /> 9I 94 e^. <br /> A Division of San Joaquin County Health Care Services 40 <br />