Laserfiche WebLink
ENVIRLOXMENTAL <br />HEALT EPARTMENT <br />° <br />.a <br />Donna K. Herain, <br />:< Direct <br />Al Olsen, R..H.s. <br />cqC; ii;P Program ul ,ager <br />FOR Laurie A. Cotull , <br />Program M <br />SAN JOAQUIN COUNTY <br />R.E.H.S. Unit Supervisors <br />304 East Weber Avenue, Third Floor Carl Borgman, R.E.H.S. <br />Stockton, California 95202-2708 Mike Huggins, R.E.H.S., R.D.I. <br />Douglas W. Wilson, R.E.H.S. <br />Tele 209 468-3420 <br />hone: () <br />R.E.H.S. p Roberet ellon, R.E.H.S. <br />ager Fax: (209) 464-0138 rtMcC <br />Mark Barcellos, R.E.H.S. <br />EMERGENCY RESPONSE RECORD <br />DATE it 2 s 0� <br />C� SHORT TERM # rC1� 6 b -L 3 3 <br />1; I rL S • CITYy G�LvtJ <br />PREMISE ADDRESS 3 <br />DBA UN)01 <br />PREMISE OWNER <br />PHONE <br />OWNER'S ADDRESS <br />FACILITY CONTACTW <br />!l <br />PHONE •% — I <br />RESPONSIBLE PARTY (RP) DBA <br />PHONE <br />RP NAME <br />RP ADDRESS <br />RP CONTACT <br />PHONE S Ll — 7O2 <br />NATURE OF COMPLAINT (explosio , <br />spill, leak, fire, or abandoned/dumped material) Sl b� �� 1 — 7'%33 <br />A4 nw— Car <br />Craw - v &4- NCO YCJI— 7702,1 M <br />TIME RECEIVED r <br />TIME OF ARRIVAL TIME OF DEPARTURE <br />PERSONS AT SCENE <br />NAME <br />a Iti <br />AGENCY PHONE TOA TOD <br />U,f 7 CY - tot 3 f) <br />IDENTIFICATION OF MATERIAL <br />SUBSTANCE FORM ❑ SOLID <br />CAL INVOLVED) D r' vD V <br />❑ POWDER ❑ GAS JKLIQUID ❑ GRANULE <br />REFERRALS TO <br />DATE MAILED <br />DATE COMPLETED ............ PROP 65 <br />1 <br />)l Z J r UAR <br />PERSONS EXPOSED and/or INJURED <br />NAME <br />ADDRESS PHONE <br />"PERSONAL TOXIC SUBSTANCE E OSURE RECORD" <br />r, R. BINDER COPIES: <br />SHORT-TERM ON TOP NARRATIVE <br />L3 EXPOSURE RECORD ❑ MANIFEST <br />❑ REFERRALS MAP <br />EH22014rev <br />COMPLETED? ❑ YES <br />❑ ANALYTICAL DATA <br />❑ CLEAN UP REPORT <br />❑ FILE CREATED <br />0 <br />PROP 65 / UAR <br />❑ OTHER AGENCY REPORTS <br />6/14/1999 <br />