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SAN J O A Q U I N Environmental Health Department <br /> EMERGENCY RESPONSE RECORD <br /> Date: August 15, 2020 Short Term#: COLABVKAP <br /> Premise Address: 23301 MACKVILLE RD City: CLEMENTS <br /> Premise DBA: Cross Street: E. MEHRTEN RD <br /> Premise Owner: CHAN SAMOEUN ETAL Owner's Phone: <br /> Mailing Address: PO BOX 575 Owner City: CLEMENTS <br /> Facility Contact: CHAN SAMOEUN ETAL Contact Phone: <br /> RP DBA: PGE <br /> Onsite RP Name: DAVE LARSEN Onsite RP Phone: (916) 897-6779 <br /> Mailing Address: 1108 MURPHYS GRADE RD. RP City: ANGELES CAMP <br /> RP Contact: ALEX STEELE Contact Phone: (209) 337-8902 <br /> NATURE OF RESPONSE (explosion, spill, leak, fire, or abandoned/dumped material <br /> 15 GALLONS OF MINERAL OIL RELEASED FROM DAMAGED POLE MOUNTED TRANSFORMER, SOIL IMPACTED NO <br /> WATER WAYS IMPACTED. <br /> Time Received: 12:30 pm Time of Arrival: 1:10 pm Time of Departure: 2:00 pm <br /> PERSONS AT SCENE <br /> NAME AGENCY PHONE TOA TOD <br /> DAVE LARSEN PGE (916) 897-6779 <br /> MATERIAL/CLASSIFICATION chemical involved <br /> MATERIAL AMOUNT SOLID(Ibsl LIQUID L_ GAS(cu ft) COMMENTS <br /> MINERAL OIL 15.00 ❑ 9 ❑ <br /> ❑ ❑ ❑ <br /> ❑ ❑ ❑ <br /> REFERRALS AND NOTIFICATIONS <br /> REFERRED TO(NAME AND ADDRESS) DATE MAILED <br /> Date Prop 65 Completed: August 17, 2020 Date UAR Completed: August 17, 2020 <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 />