Laserfiche WebLink
PUBLIC'/ HtALTH SERVIuES <br /> SAN JOAQUIN COUNTY z` <br /> ENVIRONMENTAL HEALTH DIVISION <br /> Ernest M. Fujimoto, M.D., M.P.H., Acting Health Officer .. <br /> 445 N. San Joaquin Street * P.O. Box 388 • Stockton, CA 95201-0388 <br /> (209) 468-3420 <br /> Eb R(;ENCY RESPONSE RECORD . <br /> DISTRICT# ;_J� DATE �` SHORT TERM# <br /> PREMISE ADDRESS CITY ) � n <br /> DBA r I I l - /� \c� <br /> PREMISE OWNER s N PHONE C 2 nod J / <br /> OWNER'S ADDRESS r <br /> FACILITY CONTACT i _ 1! n ( �� PHONE <br /> NATURE OF COMPLAINT (exPlosiospill, eak, or abariddned/d Ped material) <br /> r <br /> �( �'7 <br /> 33 <br /> TIME RECEIVED c7 TIME OF ARRIVAL 0 TIME OF DEPARTURE 42 <br /> d (TO ) (Tob) <br /> PERSONS AT SCENE <br /> NAME AGENCY PHONE NO. TOA TOD <br /> 5d <br /> a, __Ccu <br /> IDENTIFICATION OF MATERIAL (MIENICAL INVOLVED) Onk,1(Ai_� F11.4Lr «-t C. <br /> SUBSTANCE FORM: [ ] SOLD POWDER [ ] GAS P�UQUID [ ] GRANULE <br /> REFERRALS TO: ni �,(� DATE MAILED: 'V CT r( lu 0 in <br /> DATE COMPLETED: PROP 65 UAR <br /> PERSONS EXPOSED and/or IN <br /> NAME ADDRESS PHONE NO. <br /> r <br /> "PERSONAL TOXIC SUBSTANCE OSURE RECORD" COMPLETED? [ ] YES r� NO <br /> E_R.BINDER COPIES: <br /> [ ] SHORT-TERM ATTACHED ON OP [ ] NARRATIVE [ ] ANALYTICAL DATA [ ] PROP 65/UAR <br /> [ ] EXPOSURE RECORD [ ] MANIFEST [ ] CLEANUP FIRM REPORT [ ] OTHER AGENCY REPORTS <br /> [ ] REFERRALS [ 7 MEP [ ] FILE CREATED <br /> A Di%ision of San Joaquin County Health Care Services <br />