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SAN JOAQUIN COUNTY <br /> z. -z ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> (209)468-3420• Fax:(209) 468-3433 • Web:www.sipov.orQ/ehd <br /> EMERGENCY RESPONSE RECORD <br /> DATE: Monday May 7, 2012 SHORTTERM#: C00034942 <br /> PREMISE ADDRESS: 16888 McKinley Ave CITY: Lathrop <br /> DBA: Superstore Industries <br /> PREMISE OWNER: sante above PHONE: <br /> OWNER'S ADDRESS: Sante above CITY: <br /> FACILITY CONTACT: Mike Young PHONE: 858-3468 <br /> RESPONSIBLE PARTY(RP)DBA: Superstore Industries <br /> RP NAME: ISuperstore Industries PHONE: 858-3468 <br /> RP ADDRESS: 16888 McKinley Ave CITY: Lathrop <br /> RP CONTACT: Mike Young PHONE: 858-3468 <br /> NATURE OF COMPLAINT(explosion,spill, leak,fire, or abandoned/dumped material <br /> damaged oil filter on ice block maker machine released hydraulic oil into floor drain that leads to sewer lines but did <br /> not reach sewer. <br /> TIME RECEIVED: Sat 5/5/12 TIME OF ARRIVAL: I Mon 5/7 1 OAMI TIME OF DEPARTURE: 5/7 1030AM <br /> PERSONS AT SCENE <br /> NAME AGENCY PHONE TOA TOD <br /> Mike Young Superstore Industries <br /> IDENTIFICATION OF MATERIAL(CHEMICAL INVOLVED) I hydraulic oil <br /> PHYSICAL STATE: ❑SOLID ❑POWDER ❑GAS ❑x LIQUID ❑GRANULE <br /> REFERRALS TO: DATE MAILED: <br /> DATE COMPLETED: PROP 65: NA. no release to waterway, dirt UAR: <br /> PERSONS EXPOSED and/or INJURED <br /> NAME ADDRESS PHONE <br /> na <br /> "PERSONAL TOXIC SUBSTANCE EXPOSURE RECORD"COMPLETED? ❑YES ❑ NO <br /> E.R. BINDER COPIES: <br /> SHORT-TERM ON TOP NARRATIVE ANALYTICAL DATA PROP 65/UAR <br /> El EXPOSURE RECORD I El MANIFEST MCLEAN UP REPORT El OTHER AGENCY REPORTS <br /> REFERRALS MAP FILE CREATED <br /> Rev.04/19/12 Page 1 of 3 ER Record <br />