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PUBLIC HEALTH SERVICES <br /> ao �. <br /> SANJOAQUIN COUNTY co.r: c <br /> Joel KHANNA M.D.,M.P.H. <br /> Health Officer <br /> P.O. Box 2009 . (1601 East Hazelton Avenue) . Stockton,California 95201 c'�Faa r <br /> (209) 468-3400 <br /> PMEIZO13NCY RESPONSE RECORD <br /> Dls rRlcr DATEST # ?A09 ylo <br /> PREMISE ADDRESS an5oD <br /> DBA —�, <br /> PREMISE OWNER IF <br /> ADDRESS <br /> FACILITY CONTACT <br /> NATURE O COMPLAINT(explosion, pill,leak,fire,or abandonldmnped�erigl) <br /> W 6 � <br /> <br /> TIME RECEIVED : 30 TIME OFARRIVAL / 0. 30 TIME OF DEPARTURE. <br /> PERSONS A'I'SCENE (77JU) <br /> NAME AGENCY PRONE NO. TOA TOD <br /> <br /> IDEN111WATION OF MATERIAL PIEMICALINVOLVED) # <br /> SUBSTANCE FORM: [ J SOLID [ ] POWDER [ ] GAS [ ] LIQUID [ ] GRANULE <br /> REFERRALS TO: DATE MAILED: <br /> DATE COMPLETED: PROP 65 UAR <br /> PERSONS EXPOSED and/or INJURED <br /> NAME. ADDRESS PHONE NO. <br /> INVESTIGATION REPORT(INCLUDE FINDINGS.CLEANUP.xECOMMENDATIONS. MAP: <br /> Jm A4 <br /> 44 <br /> FILE CREATED [] MAP INCLUDED SIIORT-TRRM AT-1-ACIIED [U/ ER PILE COPY [V-"' <br /> A Division of San Joaquin County Health Care Services to <br />