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SANJOAQUIN <br /> Environmental Health Department <br />COUNTY <br />EMERGENCY RESPONSE RECORD <br />Date: November 02, 2021 Short Term #: COARKVI3W <br />Premise Address: 4929 E COLLIER RD City: ACAMPO <br />Premise DBA: Cross Street: CHEROKEE LN <br />Premise Owner: NORTH SAN JOAQUIN WATER CONSERVATION DI Owner's Phone: (209) 368-2101 <br />Mailing Address: PO BOX E Owner City: VICTOR <br />Facility Contact: NORTH SAN JOAQUIN WATER CONSERVATION DI Contact Phone: (209) 368-2101 , , <br />RP DBA: PACIFIC GAS & ELECTRIC CO <br />Onsite RP Name: Onsite RP Phone: <br />Mailing Address: PO BOX 7640 RP City: SAN FRANCISCO <br />RP Contact: ALEX STEELE Contact Phone: (209) 337-8902 <br />NATURE OF RESPONSE (explosion, spill, leak, fire, or abandoned/dumped material <br />VEHICLE STRUCK A POLE CAUSING TRANSFORMER TO RELEASE 4 GALLONS OF FR3 NON PCB OIL INTO A WET <br />ROADSIDE DITCH. NO MATERIAL RECOVERED DUE TO RAPID DISSIPATION. RESPONSIBLE PARTY HANDLING <br />CONTAINMENT AND CLEAN UP. <br />Time Received: 5:42 pm Time of Arrival: 6:30 pm Time of Departure: 6:48 pm <br />ERSONS AT SCENE <br />NAME AGENCY PHONE TOA TOD <br />DAVE LARSEN PG&E (916) 897-6779 <br />George Orosco PG&E <br />E IAL CLASSIFICATION chemical involved s <br />MATERIAL AMOUNT <br />, <br />SOLID (lbs) LIQUID (gal) GAS (cu ft) COMMENTS <br />FR3 TRANSFORMER OIL 4.00 D 0 <br />0 0 E <br />0 0 E <br />REFERRALS AND NOTIFICATIONS <br />REFERRED TO (NAME AND ADDRESS) DATE MAILED <br />Date Prop 65 Completed: November 04, 2021 Date UAR Completed: <br />IF PERSONS EXPOSED and/or INJURED, "PERSONAL TOXIC SUBSTANCE EXPOSURE RECORD"' COMPLETED? DYES ONO <br />Page 1 of 2 <br />1Q00 LJ -• 14 et et A‘rnr, ." I CfesnLefnen r`n1;fesien'in ClgOrIg I T OrIA A 1-.) 1/1 I C WW1 A a A 114 10 I tan•nat niern. ,,.-,,lLifl