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PUBLIC HEALTH SERVICES <br /> OpQ4!!'!• <br /> SAN JOAQUIN COUNIY ?' s <br /> JOG[KHANNA M.D.,M.P.H. \A ` <br /> Health Officer <br /> P.O. Box 2009 . (1601 East Hazelton Avenue) . Stockton,California 95201 ttFu6j <br /> (209) 468.3400 <br /> P-MERGENCY RESPONSE RECORD <br /> Q(b? <br /> DisTRICr DATE ST #t! O <br /> PREMISE ADDRES1),QI V6 <br /> DDA ( G(,S' U <br /> PREMISE OWNER A0 G '/ 4 T02(lff � <br /> ADDRSS 2 0 5 9 0 <br /> np / Y G <br /> FACILITY CONTACT <br /> F COMPLAINT(explosion,spill,kak fire,or abandon/dutnpedmnrerial) <br /> MiLo <br /> <br /> '1•IMERECEIVED 1a:30a, TIME OF ARRIVALfo =sSc. TIME OF DEPARTURE_ /Z=Oorp arl <br /> 1'OD) <br /> PERSONS AT SCENE <br /> NAME / AGENCYPHONE NO. 'r OA TOD <br /> joE�F/tb(r5��7yoc�Uc�i on /�i�y/ •1 l�yll�t SUGlg12_. `6t 0 [yo?Lr-537 <br /> oK_-GTc <br /> 4 . <br /> vtD/i tl AvNG�A!/�aig A. Ss3� 32tD �� <br /> IDENTIFICATION OF MATERIAL(IaaMimwvowm) G i <br /> SUBSTANCE FORM: [ ] SOLID ( ] POWDER [ J GAS [ IQUID ( ] GRANULL <br /> REFERRALS TO: / DATE <br /> MAILED: <br /> DATE COMPLETED: PROP 65 S�Zz l�I r UAR <br /> PERSONS EXPOSED and/or INJURED �5o�fj �S <br /> NAME. ADDRESS Volr (�✓'OS�oiO PIIONE NO. <br /> lvk%{•�SGO Ccv 11111A o" VAIyL 4&,:1 (a ,,kg.� <br /> INVESTIGATION REPORTcINZoE Fu4,ZcS,CIFAN.0u <br /> P,RECOMMENDATIONS d MAP): �s;/ QGat 16LeJ <br /> SrtC)-IGc� <br /> CIL s e er MSOS <br /> 2 e 37% wei [n 0A 17 's t'a W 2t e <br /> FILE CRPATEI) [ ] MAP INCLUDED (] SIIORT-TFRM ATI'ACIIED ( J ER FILE COPY (] <br /> A Division of San Joaquin County Health Cue Services <br />