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2 • , SAN JOAQUIN COUNTY <br /> ' ENVIRONMENTAL HEALTH DEPARTMENT <br /> N. I ; 600 E Main Street Stockton•CA 95202 <br /> z (209)468-3420•Fax:(209)464-0138• Web:www.sigov.org/eh <br /> ��FOR <br /> EMERGENCY RESPONSE RECORD <br /> DATE: 5-13 p -1 SHORTTERM#: COOO 'LwW <br /> PREMISE 44 4 -7 �ZRPo�i ,. I CITY: ��'` ,�� <br /> ADDRESS: g W ✓t—/ <br /> DBA: RGL <br /> OWNERS /rICVYj,Q i •� PHONE: 3 �bOO <br /> OWNER'Snn�,,rr (],, en 80u p S- 668 <br /> ADDRESS: �`�Y� 111 KPd,2 CITY: r Gg i5'�O <br /> FACILITY u� � PHONE: J <br /> CONTACT: ��l <br /> RESPONSIBLE PARTY (RP) <br /> DBA: YYI <br /> RP NAME: uv <br /> PHONE: rRP <br /> 6 6 6 $ <br /> ADDRESS: CITY: <br /> RP PHONE: J// <br /> CONTACT: <br /> NATURE OF COMPLAINT(explosion, spill, leak, fire,Or abandoned/dumped material) <br /> TLS pub IW"t � <br /> RECEIVED: (� - 7 Q TIME OF ARRIVAL: <br /> PERSONS AT SCENE <br /> NAME AGENCY PHONE TOA TOD <br /> Da 1 2 K cry <br /> 662 1� <br /> IDENTIFICATION OF MATERIAL(CKEMWc wvoLVE.) <br /> FUO ANCE ILD POWDER GAS LIQUID GRANULE <br /> REFERRALS DATE <br /> TO: MAILED: <br /> DATE COMPLETED,...PROP UA <br /> 65: <br /> R: <br /> PERSONS EXPOSED and/or INJURED <br /> NAME ADDRESS <br /> PHONE <br /> "PERSONAL <br /> TOXIC <br /> SUBSTANCE EXPOSURE RECORD" COMPLETED? YES NO <br /> ER RECORD MODIFIED Page 1 of 4 05/01/2007 <br />