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FILE COPY <br /> San Joaquin County DIRECTOR <br /> Donna Heran, REHS <br /> onmental Health Department <br /> ASSISTANT DIRECTOR <br /> 2a 600 East Main Street Laurie Cotulla,REHS <br /> Stockton, California 95202-3029 PROGRAM COORDINATORS <br /> Carl Borgman,REHS <br /> Website: www.sjyov.or /ehd Mike Huggins,REHS, RDI <br /> g L i F 60�\ g Margaret Lagorio,REHS <br /> Phone: (209) 468-3420 Robert McClellon, REHS <br /> Fax: (209)464-0138 Jeff Carruesco,REHS, RDI <br /> r l EMERGENCY RESPONSE RECORD KaseyFoley, REHS <br /> DATE: l I J r f D SHORT TERM#: C D 0 D ,, ! j 8t) <br /> PREMISE ADDRESS: Z. N . V N Ut,1 1. CITY: S4oGlL--&-l0�_j <br /> DBA: ( U ( I`L:::j 04,(e, MPeA d-- I < < Zo03 <br /> PREMISE OWNER: W nL��1�Q� '� �y I\�l PHONE: <br /> OWNER'S ADDRESS:—L.. 0 ( b6x. �22 � D P��b C r,� I �S—L <br /> FACILITY CONTACT: 1v Qe p / PHONE: <br /> RESPONSIBLE PARTY(RP)DBA: Iy • f <br /> RP NAME: (Z. <br /> . A l G>0 S�-e�/� PHONE: <br /> RP ADDRESS: Q D AA V co �o/�Qn _ISA^��I �Aai4YJ <br /> RP CONTACT: PHONE: <br /> NATURE OF COMPLAINT(explosion, spill, leak, fire, or abandoned/dumped material) <br /> A ) <br /> TIME RECEIVED: t TIME OF ARRIVAL: U S,'W4 - TIME OF DEPARTURE: IC4146rD <br /> PERSONS AT SCENE <br /> NAME AGENCY PHONE TOA TOD <br /> IDENTIFICATION OF MATERIAL(CHEWCALNVOLVED)7-r 4^J 4Wmt,.. <br /> SUBSTANCE FORM ❑SOLID/� ❑ POWDER ❑ GAS LIQUID []GRANULE <br /> REFERRALS TO: V Q—hj Q C.' 1 -T5(— DATE MAILED: D <br /> DATE COMPLETED........PROP 65: 14 UAR: <br /> PERSONS EXPOSED and/or INJURED <br /> NAME ADDRESS PHONE <br /> r <br /> "PERSONAL TOXIC SUBSTANCE EXPOSURE RECORD" COMPLETED? ❑ YES TKtNO <br /> E.R. BINDER COPIES: <br /> EHORT-TERM ON TOP 'K NARRATIVE NALYTICAL DATA PROP 65/ UAR <br /> XPOSURE RECORD ❑ MANIFEST CLEAN UP REPORT ❑ OTHER AGENCY REPORTS <br /> ❑ REFERRALS �a MAP ❑ FILE CREATED <br /> Document t Page: l of 3 6/14/1999 <br />