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SAN J O A Q U I N Environmental Health Department <br /> C `)uNry <br /> EMERGENCY RESPONSE RECORD <br /> Date: September 07, 2019 Short Term#: COHBWMPSB <br /> Premise Address: EMPIRE TRACT RD City: STOCKTON <br /> Premise DBA: Cross Street: EIGHT MILE RD <br /> Premise Owner: Owner's Phone: <br /> Mailing Address: Owner City: <br /> Facility Contact: Contact Phone: <br /> RP DBA: <br /> Onsite RP Name: David U7r( C, LA)cVar Onsite RP Phone: <br /> Mailing Address: „MC0 : e_,rj G 10d4Ard LQ(-1 q ahoo.Lorn RP City: <br /> RP Contact: P(AVA 1Ur(L "dz-ao Contact Phone: <br /> NATURE OF RESPONSE(explosion, spill, leak, fire, or abandoned/dumped material <br /> —POTENTIAL RELEASE** <br /> PER NRC REPORT: CALLER IS REPORTING A POTENTIAL DISCHARGE OF AN UNKNOWN AMOUNT OF OIL INTO <br /> LITTLE POTATO SLOUGH AT THE COORDINATES PROVIDED. DISCHARGE IS FROM A VESSEL THAT IS TAKING <br /> ON WATER. REMEDIAL ACTIONS: TRYING TO GET PUMPS RUNNING TO PUMP OUT THE WATER. <br /> VESSEL INFORMATION: Name: CHALEUR, Number: 1116488 <br /> Time Received: 1:24 pm Time of Arrival: Time of Departure: <br /> PERSONS AT SCENE <br /> NAME AGENCY PHONE TOA TOD <br /> DAVID ERICK LOCKARD VESSEL OWNER <br /> DEPUTY BRYAN MERRITT SJC SHERIFF (209)456-6027 <br /> ANDREW CHRISTOPHERSON COASTGUARD (510)928-9939 6:40 pm <br /> JASON RAYMOND COAST GUARD (516)697-9664 6:40 pm <br /> MATERIAL/CLASSIFICATION chemical involved <br /> MATERIAL AMOUNT SOLID(lbs) LIQUID(gal) GAS(Cu ft) COMMENTS <br /> OIL VY1"4wrt ❑ ❑ <br /> ❑ ❑ ❑ <br /> ❑ ❑ ❑ <br /> REFERRALS AND NOTIFICATIONS <br /> REFERRED TO(NAME AND ADDRESS) DATE MAILED <br /> COAST GUARD <br /> Date Prop 65 Completed: September 10, 2019 Date UAR Completed: <br /> IF PERSONS EXPOSED and/or INJURED,"PERSONAL TOXIC SUBSTANCE EXPOSURE RECORD"COMPLETED? ❑YES ❑NO <br /> Page 1 of 2 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sjrehd.com <br />