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SAN 10 A 0 U 1 N Environmental Health Department <br /> —COUNTY <br /> EMERGENCY RESPONSE RECORD <br /> Date: February 08, 2021 Short Term#: COOXNCAZX <br /> Premise Address: 12355 W HWY 12 City: LODI <br /> Premise DBA: Cross Street: CORREIA RD <br /> Premise Owner: OLAGARAY BROTHERS Owner's Phone: <br /> Mailing Address: 2375 W ARMSTRONG RD Owner City: LODI <br /> Facility Contact: OLAGARAY BROTHERS Contact Phone: <br /> RP DBA: OLAGARAY BROTHERS <br /> Onsite RP Name: Onsite RP Phone: <br /> Mailing Address: 2375 W.ARMSTRONG RD. RP City: LODI <br /> RP Contact: LODI Contact Phone: <br /> NATURE OF RESPONSE(explosion,spill, leak,fire, or abandoned/dumped material <br /> APPROXIMATELY 6 PEOPLE SPRAYED WITH ROUND UP, BEING TREATED AT LODI MEMORIAL HOSPITAL. <br /> Time Received: 4:20 pm Time of Arrival: Time of Departure: <br /> PERSONS AT SCENE <br /> NAME AGENCY PHONE TOA TOD <br /> MIKE ALEGRE LODI FIRE DEPT. (209)470-0357 2:30 pm 3:20 pm <br /> MATERIAL/CLASSIFICATION chemical involved <br /> MATERIAL AMOUNT SOLID(Ibs) LIQUID(gal) GAS(cu ft) COMMENTS <br /> ROUND UP POWER MAX. ❑ ❑ ❑ <br /> ❑ ❑ ❑ <br /> ❑ ❑ ❑ <br /> REFERRALS AND NOTIFICATIONS <br /> REFERRED TO(NAME AND ADDRESS) DATE MAILED <br /> DR. MAGGIE PARK; MPARK@SJCPHS.ORG February 08, 2021 <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 />