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' SAN JOAQUIN COUNI . <br /> = ENVIRONMENTAL HEALTH DEPARTMENT <br /> All <br /> 1868 E. Hazelton Ave., Stockton • CA 95205 <br /> ' P (209)468-3420 • Fax;(209)468-3433 - Web:www.sjgov.org/ehd <br /> LIF ORS <br /> EMERGENCY RESPONSE RECORD <br /> DATE:FLYING J TRAVEL PLAZA#618" SHORTTERM#: COXMY06K2 <br /> PREMISE ADDRESS:1501 N JACK TONE RD CITY:Ripon <br /> DBA:FLYING J ICROSS STREET:Santos Avenue <br /> PREMISEOWNER:PILOT TRAVEL CENTERS LLC PHONE: <br /> OWNER'SADDRESS:5508 LONAS RD KNOXVILLE, TN37939 CITY: <br /> FACILITY CONTACT:Scott Brandau PHONE:209-324-4899 <br /> RESPONSIBLE PARTY(RP)DBA:PILOT TRAVEL CENTERS LLC <br /> RP NAME:as above PHONE:(865) 588-7488 <br /> RP ADDRESS: CITY: <br /> RP CONTACT: PHONE: <br /> NATURE OF RESPONSE(explosion,spill,leak,fire,or abandoned/dumped material) <br /> Approximately 2 gallons of diesel fuel spilled in the parking lot of the facility some of the diesel fuel <br /> entered the onsite storm drain <br /> TIME RECEIVED:5:12 pm TIME OF ARRIVAL:6 pm TIME OF DEPARTURE:8.40 pm <br /> PERSONS AT SCENE <br /> NAME AGENCY PHONE TOA TOD <br /> Jena Manzo SJC EHD 09-953-7699 6 pm 8:40 pm <br /> Ty Reguera Patriot 916-936-7984 onsite 8:30 pm <br /> MATERIAL/CLASSIFICATION(CHEMICAL INVOLVED) <br /> D <br /> IDENTIFICATION SPILLED? SOLID LIQUIGAS(LBS) (GAL) (CU M COMMENTS <br /> Diesel X Y ❑N 2 some entered the storm drain <br /> waste absorbent ❑Y X N 30 clean up debris <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> o o <br /> o o <br /> REFERRALS AND NOTIFICATIONS <br /> REFERRED TO(NAME AND ADDRESS) DATE MAILED <br /> DATE PROP 65 COMPLETED: 2-16-16 1 DATE UAR COMPLETED: <br /> IF PERSONS EXPOSED and/or INJURED,"PERSONAL TOXIC SUBSTANCE EXPOSURE RECORD"COMPLETED? ❑ YES ❑ NO <br /> ER BINDER COPIES: <br /> )I* SHORT-TERM ON TOP I ❑ NARRATIVE MAP ❑ ANALYTICAL DATA ,lei PROP 65/UAR ❑ FILE CREATED <br /> ❑ MANIFEST ❑ REFERRALS ❑ CLEANUP REPORT ❑ OTHER AGENCY REPORTS ❑ EXPOSURE RECORD X PHOTOS <br /> ER RECORD Page 1 10/03/12 <br />