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CO004CN0S (2)
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2500 – Emergency Response Program
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CO004CN0S (2)
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Last modified
8/25/2021 2:49:02 PM
Creation date
8/25/2021 2:41:09 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2500 – Emergency Response Program
RECORD_ID
CO004CN0S
PE
2546
STREET_NUMBER
12700
Direction
S
STREET_NAME
HARLAN
STREET_TYPE
RD
City
LATHROP
Zip
95330
APN
19603008
ENTERED_DATE
4/15/2021 12:00:00 AM
SITE_LOCATION
12700 S HARLAN RD
RECEIVED_DATE
4/15/2021 12:00:00 AM
P_LOCATION
07
P_DISTRICT
003
QC Status
Approved
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SJGOV\ymoreno
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EHD - Public
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SANdOAQUIN <br /> Environmental Health Department <br />COUNTY <br />EMERGENCY RESPONSE RECORD <br />Date: April 15, 2021 Short Term #: C0004CNOS <br />Premise Address: 12700 S HARLAN RD City: LATHROP <br />Premise DBA: Cross Street: SLATE <br />Premise Owner: LUIS P SEGURA Owner's Phone: <br />Mailing Address: 11023 N MICKE GROVE RD Owner City: LODI <br />Facility Contact: LUIS P SEGURA Contact Phone: <br />RP DBA: <br />Onsite RP Name: Onsite RP Phone: <br />Mailing Address: RP City: <br />RP Contact: Contact Phone: <br />NATURE OF RESPONSE (explosion, spill, leak, fire, or abandoned/dumped material) <br />APPROXIMATELY 12 GALLONS OF DIESEL RELEASED FROM VEHICLE ACCIDENT. RESPONSIBLE PARTY LEFT <br />WITHOUT CLEAN-UP <br />Time Received: 6:36 pm Time of Arrival: 7:40 pm Time of Departure: 8:04 pm <br />PERSONS AT SCENE <br />NAME AGENCY PHONE TOA TOD <br />Lydia Baker SJC EHD (209) 616-3046 7:40 pm 8:04 pm <br />Scott B Manteca Fire (209) 275-7420 <br />LCLASSIFICATION chemical involved <br />MATERIAL <br />. <br />AMOUNT <br />. <br />SOLID (lbs) LIQUID (gal) GAS (Cu ft) COMMENTS <br />Diesel 12.00 0 N 0 <br />0 0 0 <br />0 0 0 <br />REFERRALS AND NOTIFICATIONS <br />REFERRED TO (NAME AND ADDRESS) DATE MAILED <br />Date Prop 65 Completed: April 15, 2021 Date UAR Completed: <br />IF PERSONS EXPOSED and/or INJURED, "PERSONAL TOXIC SUBSTANCE EXPOSURE RECORD COMPLETED? OYES ONO <br />Page 1 of 2 <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjgov.org/EHD
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