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J . <br /> r - <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> SAN JOAQUIN COUNTY <br /> A. <br /> Unit Supervisors <br /> ? Donna K.Heran,R.E.H.S. Carl Bergman,R.E.H.S. <br /> N 1 Director 304 East Weber Avenue, Third Floor Mgg <br /> ike Huins,R.E.H.S.,R.D.I. <br /> 3.F Al Olsen,R.F.H.S. Stockton, California 95202-2708 <br /> Douglas W.Wilson,R.E.H.S. <br /> �.. „� �P • Program Manager Telephone: (209) 46$-3420 Margaret Lagorio,R.E.H.S. <br /> LiFPi0ti Laurie A.Cotulla,R.E.H.S. Robert McClellon,R.E.H.S. <br /> Program Manager FaX: (209} 464-013$ Mark Barcellos,R.E.H.S. <br /> EMERGENCY RESPONSE RECORD Q <br /> DATE 16 Z SHORT TERM# GC9 80 � / 8 5� -- <br /> PREMISE ADDRESS ! 1 N• L Qor�o 5>f CITY_S�'13LIL�a <br /> DBA <br /> PREMISE OWNER tJ4L V -E' C-421-110.— PHONE <br /> Q OWNER'S ADDRESS Zl1 �C �rl�Nb Lip. 5 � C � 2� <br /> PHONE <br /> FACILITY CONTACT N 1R <br /> i <br /> RESPONSIBLE PARTY(RP)DBA—(7920-r> JOYAPAAjex, <br /> _ <br /> RPNAME G V- Jzy PHONE 00 �ob 2Z <br /> rI <br /> RP ADDRESS l 100G . 72 3 S�- CAr C Or v-7 <br /> RP CONTACT r G V. PHONE <br /> NATURE OF COMPLAINT(explosion,spill,leak,fire,or abandoned/dumped material) <br /> tU tr1 a" <br /> TIME RECEIVED r D TIME OF ARRIVAL .2 �"� _ <br /> TIME O 1E RLQ <br /> Lt.2/sfm <br /> PERSONS AT SCENE PHONE TOA TOD <br /> NAME AGENCY <br /> f 1 U L./r �t7 C} L01"ti 4�1� g aD 661 42'L <br /> S� r,,A 602 — 767 Z:ZD 7't3� n <br /> S�r� gr✓�.�� S. sc. E. 4,r) . 4- 311(40 3: <br /> Ill ;a0 <br /> inert b � l L 1 D o G r3 <br /> IDENTIFICATION OF MATERIAL(cH,mncu.sHvoLveo) UID ❑ GRANULE <br /> SUBSTANCE FORM ❑SOLID ❑ POWDER 13 GAS Ll Q <br /> REFERRALS TO DATE MAILED <br /> DATE COMPLETED............PROP 65 16 2 UAR j <br /> r <br /> PERSONS EXPOSED and/or INJURED <br /> ADDRESS PHONE <br /> NAME <br /> "PERSONAL TOXIC SUBSTANCE EXPOSURE RECORD" COMPLETED? ❑YES NO <br /> E.R.BINDER COPIES: PROP 651 UAR <br /> SHORT-TERM ON TOP NARRATIVE '�ANALYTICAL DATA <br /> ❑ EXPOSURE RECORD MANIFEST ❑ CLEAN UP REPORT ❑ OTHER AGENCY REPORTS <br /> ❑ REFERRALS MAP ❑ FILE CREATED <br /> 6/14/1999 <br /> 4v7']rt9 4rov - <br />