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ENVIRO_,.�'WIENTAL HEALTI,.-DEPARTMENT <br /> N c SAN JOAQUIN COUNTY PRE. <br /> ). C <br /> Donna K.Heran,R.E.H.S. <br /> t <br /> Director 304 East Weber Avenue, Third Floor ar] m . . <br /> AI Olsen,R.E.H.S. Stockton, California 95202-2708 Mike Huggins,R.E.H.S.,R.D.J. <br /> •. c • er rani Pro Manager Douglas W.Wilson,R.E.H.S. <br /> QC jp p"aN� g g <br /> Laurie A.Cotulla,R.E.H.S. Telephone: (209) 468-3420 Margaret La orio,R.E.H.S. <br /> ellon,R.E.H.S. <br /> Program Manager Fax: (209) 464-0138 Robert McC <br /> EMERGENCY RESPONSE RECORD Mark 13arcellos,R.E.H.S. <br /> DATE b l 6 j D-7 SII /+ORT TERM# C�b 0612– 0 <br /> PREMJSE ADDRESS Lor ro,,r� 4 guf-numnq CITY 4oc,KC orj <br /> DBA ^f <br /> PREMISE OWNER PHONE <br /> OWNER'S ADDRESS P-0 • /2vX V, <br /> FACILITY CONTACT—&A ii 41n A ll t, L Q.. PHONE b r D <br /> RESPONSIBLE PARTY(RP)DBA <br /> RP NAME PHONE <br /> RP ADDRESS <br /> RP CONTACT PHONE <br /> NATURE OF COMPLAINT(explosion,spill,leak,fire,or abandoned/dumped material) <br /> V4-d •� rA� �M�'Z 2 fG lwj i� f L Ar-r— , -rj &A l l</1 <br /> TIME RECEIVED 1( '51 A TIME OF ARRIVAL Z r TIME OF DEPARTURE--- <br /> PERSONS <br /> EPARTURE _PERSONS AT SCENE <br /> NAME AGENCY PHONE TOA TOD <br /> IDENTIFICATION OF MATERIAL(ommc LrKv vEu) r,e1' � n' O e L_ <br /> SUBSTANCE FORM ©SOLID ❑ POWDER ❑ GAS "LIQUID D GRANULE <br /> REFERRALS TO DATE MAILED <br /> DATE COMPLETED............PROP 65 i1 1 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 WNARRATIVE ❑ ANALYTICAL DATA C PROP 65/UAR <br /> © EXPOSURE RECORD ❑ MANIFEST ❑ CLEAN UP REPORT ❑ OTHER AGENCY REPORTS <br /> ❑ REFERRALS MAP ❑ FILE CREATED <br /> EH22014rev <br /> 6/14/1999 <br />