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RP CONTACT: 71/A721d1 Onmio-/-ail <br />.41,5/12_ <br />00 pm TIME OF ARRIVAL: P.3e2,/,7 TIME OF DEPARTURE: <br />NATURE OF COMPLAINT (explosion, spill, leak, fire, or abandoned/dumped material <br />-c 1 cat an --17-Lndkrate4 0-71 <br />(a .d inaz_i_e7/e66 <br />rP -41-41/012in TIME RECEIVED: <br />RP <br />NAME: <br />PHONE <br />CITY: Tr, RP ADDRESS: /OD uf i://2/14e7 <br />(2,0 ,T)eo40-2 ;c7e,c( PHONE <br />Alve-e-40 777 10-77th13 -7 24L-e RESPONSIBLE PARTY (RP) <br />DBA: <br />SAN 30AQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 E Main Street Stockton • CA 95202 <br />(209) 468-3420 - Fax: (209) 464-0138 - Web: www.sigov.org/ehd <br />EMERGENCY RESPONSE RECORD <br />DATE: •`-t i 1,5 /2_ SHORT TERM#: C000 <br />PREMISE <br />ADDRESS: ( /0/ 0 0 w . ,4r2e /.ett. CITY: <br />DBA: Arr/IA o---n rthierrieloCTI-7 a-e <br />PREMISE <br />OWNER: <br />/0 (..a gy 7%,:rt,iti (7 Bi'ved , ZV2_/ PHONE: . <br />OWNER'S ADDRESS: CITY: gafithip eteemo .,/, <br />FACILITY CONTACT: 77107748Z 4,00774ccWell PHONE: E\040 -5 -0 .-(.9 y „ f, y <br />NAME AGENCY PHONE TOA TOD <br />I71aMe_4i) WarraCizth Airtgl)ern (247 ,1)8 -, anz, _ ILA, <br />Y .309 <br />Obi"- 7:3friziv Leo Aini4o-ri tem) ree", 65- 0 --a un L zi-41__. <br />ATI N OF MATERIAL CHEMICAL NVOLVED <br />SUBSTANCE FORM SOLID POWDER GAS )(1 LIQUID GRANULE <br />REFERRALS TO: DATE MAILED: <br />DATE COMPLETED.. ..PROP 65: -11 /1.2., UAR: <br />EXPOSED and/or INJURED <br />NAME ADDRESS PHONE <br />ti-nkriaan <br />"PERSONAL TOXIC SUBSTANCE EXPOSURE RECORD" COMPLETED? YES NO <br />ES: <br />)(; SHORT-TERM ON TOP 1 P Ill NARRATIVE ><ANALYTICAL DATA "c PROP 65/ UAR <br />EXPOSURE RECORD "Tp MANIFEST CLEAN UP REPORT OTHER AGENCY REPORTS <br />REFERRALS 'III MAP FILE CREATED <br />ER RECORD ELECTRONIC VERSION Page 1 of 4 01/16/09