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01/13/2015 12:56 2@99821303 STOCKTONWOODSHAVINGS PAGE 02 <br />CALWORMA ENMONWNTAL REPORTING MMM (CERS) <br />Z IC -Y TREKSPONSE / CO GENCY FLA' \T <br />NTIN 0\ <br />F, !CC; erefeT to d2c CO:' Pi_Ej=GA C07VSi2L7DA7V_0CWn7NGENCYPLtV <br />A. T�ACTLITVIDI�—�NTMCATIONAND.,ZDpERAT— <br />kONS (D-v-ERVW4,W <br />FACILITY ID n AL D L <br />C -ERS ID A-, E OF �M��REPARATIONMEVJSION Al <br />I <br />�iF <br />Ills. NAME (Same as Faci lity Nme or -Do 57,3177'm A-,) 3. <br />4CO) J"V cr L; <br />BUSLNESS Sri b ADDRESS <br />ct __Z39 � - F(__ P <br />BUSINESS SITE Cl iY F <br />zfP CODE <br />CA <br />451 S-,) <br />toFek <br />'USM -SS (e.g., Painting CctrtAictor) Al TNCTDENTALOPFRATIONS(e.g�,FILt,,tl%laiotci=ce) A <br />=!�_ �_D Iprid Ck I <br />TWS PLAN COVERS <br />CHEMICAL SPK.LS, FIRES, AND EARTHQUAKESjKV0LVJN6Z (Claes* all Ougopply) A51 <br />1 - HAZARDOUS MATERIALS; I : 1HA7_,ARDOUS WASTES <br />IL JNTERNASL RESPONSE <br />INTERNAL FACTLJTY EKEROENCY RESPONSE WILL OCCUR VIA: (Cbo*,41 that apply) B7. <br />9 1. CALLING PUBLIC EMERGENCY RESPONDERS (i.e., 9-1-1) <br />�d 2- CALLING HAZARDOUS WASTE CONTRACTOR <br />N 3. ACTIVATING IN -ROUSE awltRGENcy REspoNjsp TEAm <br />C. EMERGENCY COWMNICATIONS, PHONE NUNMERS AND NOMCATIONS <br />WIM19ver there is an imminent or aural ciricrgency *ftuRtion such as M explosion, fire, or release, the Fxxrg=cy Coordinator (or hieJber de3igace when the <br />Emergency Coonlinaw is on call) 4ia: <br />1. Activate internal facility alarms or communications .7rzn-, whom applicable,notify pert <br />to a . -111 ficility ouncl. <br />2. Notify appropriate lociij authorities (Le-, e4l 9- 1 -1). <br />3. No* the California ErcrgeDcy Mlaaagev=t Agency at (800) 852-7550. <br />Befrre facility operations are re=jed in area$ Of 09 f4kWitY Pff*Vtd by die incident, 6e cMmrncy coordinator shall notify the California Department of Toxic <br />Substances Cmtrol (DTSQ, the trAal Tjoified PmStam Agmey (UPA). =d the total fire department':; hazardous <br />matm-ialzi prog= that the facility is in compliance <br />with rNuirvincuts to: <br />I- Provide for proper stumgt: ewd disposal of rccovc=d waste, contaminated go,] or surface water, or any other material tbatrcsulu from an crplt)cion, fife, or rcica5z at <br />the facility-, aud <br />2- Enpre that no Matelial that i.- ir,cQmpjtl4e with the rclmscd material is timsfmTd, stored, or disposed of in arc:* of the facility affected by the incident until <br />— clean o pr2ESSLums = completed. <br />INTERNAL FACILITY FWRGEN CY COOT MMCATIONSORALARM NOTIFICATION WILL OCCUR VIA: (Check all that apply) C1. <br />OA 1. VERNAL WARNINGS; [ 1 2. PUBLIC ADDRESS OR INTERCOM SYSTEM; j 3. TELEPHONE; <br />14. PAGERS, F3 S. ALARM SYSTEM; 6. PORTABLE RADIO <br />NO! 1FICATIONS TO NEIGHBORING FACILITIES THAT MAY BE AFFTCTED BY AN OFF -STI REVLTASJ� WILL OCCUR BY: (Check all that apply) ra <br />Nr <br />1. VERBAL WARNE40S; F__J 2. PUBLIC ADDRESS OR INTERCOM SYSTEM; X_ -TELEPHONE; <br />Ll 4. YAOF <br />_jzS; L 15. ALARM SYSTEM; 6. PORTABLE RADIO <br />EMERGENCY RESPONSE AMBULANCE, FIRE, POLICE AND cRP ........ ............ .... ................ 9-1-1 <br />PHONE NUMBERS: <br />CALIFORNIA EMERGENCY MANAGEMkNT AOr-Nf--Y (CAL.TMA) .................... ­ (800) 862-7550 <br />NATIONAL RESPONSE CENTER (NRC), .... . ....... ............................... (800) 424-8802 <br />POISON CONTROL CENTER ............................................... (800) 222-1222 <br />LOCAL UNIFIED nOQtRAlA AGENCY (UPAICTUPA0 -q.-2/v. vl'oRN: �4' zk " ? C3 <br />C4. U7 <br />OTHER (Srccify): <br />NEAREST MEDICAL FACILITY /HOSPJTAL NAME:! 4v 0 <br />AGENCY NOT)FlCA*nQN PHONE. NIAIBERS: CALIFOR DEPT OF TOXIC SUBSTANCES CONTROL (DTSQ .... (916) 256-3646 <br />REGIONAL WATER QUALITY CON770L BOARD .................. <br />U.S. ENN-IRCINMM-ITAL FROTECT70N AGENCY (US UA) ........... (8W) 300-2193 <br />CALIFORNIA DEPT OF FISH AND CAIm (DFC,) .................... (916) 358-2900 <br />U.S. COAST GUARD ................ ............................ (202) 267-2180 <br />CALJOSHA ................................... ........... _ _ (916) 263-2800 <br />STATE FIRE MARSHAL ........................................... (916) 445-8200 <br />OTITBP (Spogify); !She L k—U j <br />OTHERtspccafyl:I rSf; r�_�X R/IJ,GL .i l_ err 'fj/r1+90u/ IZ <br />Rev. 06/27/11 <br />