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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 E Main Street Stockton m CA 95202 <br />(209) 468 -3420 • Fav (209) 464-0138 w Web: www.sigov.orgLehd <br />EMERGENCY RESPONSE RECQRD <br />DATE: <br />SHORT TERM#: <br />0000 3 <br />PREMISE <br />I <br />CITY: <br />T <br />MAILED: <br />ADDRESS: <br />DATE COMPLETED.—PROP <br />UA <br />DBA- <br />�RP <br />(A <br />PREMISE <br />PHONE: <br />OWNER: <br />OWNER'S <br />CITY: <br />ADDRESS: <br />FACILITY <br />PHONE: <br />CONTACT: I <br />RESPONSIBLE PARTY (RP) <br />PHONE <br />DBA: <br />rl <br />TO: <br />MAILED: <br />DATE COMPLETED.—PROP <br />UA <br />I <br />�RP <br />R-. <br />NATURE OF COMPLAINT (explosion, spill, leak, fire, or abandoned/damped material) <br />ell Cw� c"w calyx" acA"d <br />V <br />TIME OF ARRIVAL: TIME 7OFT <br />RECEIVED: TIME DEPARTURE: <br />"�,"V�VTO A <br />IDENTIFICATION OF MATERIAL (cmmicAL INVOLVED) <br />SUBSTANCE L so <br />FORM I LIDPOWDER GAS [LIQUID GRANULE <br />REFERRALS <br />PHONE <br />DATE <br />TO: <br />MAILED: <br />DATE COMPLETED.—PROP <br />UA <br />I <br />65.- <br />R-. <br />PP.R.qt'lTlJ.'IZ PXW).RPr) nnii/nr TMITTRPTl <br />NAME ADDRESS <br />PHONE <br />"PERSONAL TOXIC SUBSTANCE EXPOSURE RECORD" COMPLETED? <br />YES <br />NO <br />ER RECORD MODIFIED Page 1 of 4 1 05/01/2007 <br />