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SAN -J0AQUIN Environmental Health Department <br /> _ COUN 'TY---- <br /> EMERGENCY RESPONSE RECORD <br /> Date: October 29, 2020 Short Term#: C00052877 <br /> Premise Address: 7151 EST RT 88 City: STOCKTON <br /> Premise DBA: Cross Street: ASHLEY <br /> Premise Owner: DAVID NICHOLAS RAJKOVICH Owner's Phone: <br /> Mailing Address: 5220 N ASHLEY LN Owner City: STOCKTON <br /> Facility Contact: DAVID NICHOLAS RAJKOVICH Contact Phone: <br /> RP DBA: DAVID NICHOLAS RAJKOVICH <br /> Onsite RP Name: Onsite RP Phone: <br /> Mailing Address: 5220 N ASHLEY LN RP City: STOCKTON <br /> RP Contact: DAVID NICHOLAS RAJKOVICH Contact Phone: <br /> NATURE OF RESPONSE (explosion, spill, leak, fire, or abandoned/dumped material <br /> COMPLAINANT STATES A FIVE GALLON WATER JUG FILLED PARTIALLY WITH AN UNKNOWN RED LIQUID WAS <br /> FOUND BY A ROAD MAINTENANCE CREW MEMBER. THE JUG CONTAINS APPROXIMATELY ONE-GALLON OF <br /> WHATAPPEARS TO BE TRANSMISSION FLUID. THE JUG IS OUTSIDE OF THE COUNTY RIGHT OF WAY, LOCATED <br /> ON THE EAST SIDE OF THE ROADWAY. SEE ATTACHED PICTURES <br /> Time Received: Time of Arrival: Time of Departure: <br /> PERSONS AT SCENE <br /> NAME AGENCY PHONE TOA TOD <br /> MATERIAL/CLASSIFICATION chemical involved <br /> MATERIAL AMOUNT SOLID(Ibsl LI UID a GAS(cu ft) COMMENTS <br /> ❑ ❑ ❑ <br /> ❑ ❑ ❑ <br /> REFERRALS AND NOTIFICATIONS <br /> REFERRED TO(NAME AND ADDRESS) DATE MAILED <br /> Date Prop 65 Completed: 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 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />