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FILE COPY <br /> San Joaquin County DIRECTOR <br /> HS <br /> Environmental Health Department Donna ASSIHeran,STANT <br /> ECTASSISTANT D/RECTOR <br /> a 1- % 600 East Main Street Laurie Coluila, REHS <br /> "I a Stockton California 95202-3029' <br /> ( r PROGRAM COORDINATORS <br /> - - - Cad Borgman,REHS <br /> '�" •^p'- Mike Huggins,REHS,RDI <br /> cq Fo:R N� Website: www.sjgoV.Orglehd Margaret Lagodo,REHS <br /> Phone: (209) 468-3420 Robert McClellon,REHS <br /> Fax: (209)464-0138 Jeff Carruesco,REHS,:RDI <br /> EMERGENCY RESPONSE RECORD Kasey Foley,REHS <br /> DATE: N l Z311 -2- SHORT TERM N: C O ODs Ltirl DCj <br /> PREMISE ADDRESS: D 2 P 1JU 6� r-I A/ 61" CITY: 3�• IL I-pi <br /> DBA: Corl-.N Pro4jlfL� CALFMn- SZ1941 0- - T(23 <br /> PREMISE OWNER: Qua OVC, PHONE: <br /> OWNER'S ADDRESS: In 9prp� 1. ,D <br /> FACILITY CONTACT•: R 00 V O r g " �L PHONE: V-i-7 Dp. 3? <br /> RESPONSIBLE PARTY(RP)DBA:. S&r-t� A4 $201,10— <br /> RP NAME: PHONE: <br /> RP ADDRESS: . <br /> RP CONTACT: PHONE: <br /> NATURE OF COMPLAINT(explosion, spill, leak, fire, or abandoned/dumped material) <br /> Q ISZAIC �t LUr� �pI`^ A eA I CTU^'\ l4JrdKkA-4 <br /> TIME RECEIVED: U '�I D TIME OF ARRIVAL: ` 1 L"P TIME OF DEPARTURE: 3�P <br /> PERSONS AT SCENE ' <br /> NAME AGENCY PHONE TOA TOD <br /> 2 tigLe 233 — — <br /> IDENTIFICATION OF MATERIAL iu�.wcnr.erva�vcnr C� G rl uN. <br /> SUBSTANCE FORM ❑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 - - <br /> "PERSONAL TOXIC SUBSTANCE EXPOSURE RECORD" COMPLETED? ❑ YES NO <br /> E. R. BINDER COPIES: - <br /> SHORT-TERM ON TOP. NARRATIVE ❑ ANALYTICAL DATA PROP 65/UAR <br /> EXPOSURE RECORD MANIFEST ❑ CLEAN UP REPORT ❑ OTHER AGENCY REPORTS <br /> ❑ REFERRALS - `�MAP ❑ FILE CREATED " <br /> Documrn[I Page: i of 3 6/14/1999 <br />