Laserfiche WebLink
�1N SAN JOAQUIN COUNTY <br /> - g ENVIRONMENTAL HEALTH DEPARTMENT <br /> `! 600 E Main Street Stockton•CA 95202 <br /> (209)468-3420■Fax. (209)464-0138 • Web.www.sigov.or&Lghd <br /> EMERGENCY RESPONSE RECORD q <br /> DATE: �-r�� O� SHORT TERM#: COOO lI � <br /> PREMISE 1 C CITY: <br /> ADDRESS: J <br /> DBA: 14 6P <br /> PREMISE s PHONE: <br /> OWNER: -lodb�4 <br /> OWNER'S 1 c�a1 ^J r l CITY: <br /> ADDRESS: <br /> FACILITY PHONE: <br /> CONTACT: <br /> RESPONSIBLE PARTY (RP) <br /> DBA: LJ�.YV L.Ct�( <br /> RP NAME: tll PHONE: _ <br /> RP Or-� .i— `�-D• Q CITY: <br /> ADDRESS: <br /> RP PHONE: <br /> CONTACT: <br /> NATURE OF COMPLAINT(explosion, ill eak fire,or abandoned/dumped material) ! <br /> 4,e- 6& 4Mk ph) ob� ani <br /> 1 <br /> TIME I` [� TIME OF ARRIVAL: �� TIME <br /> DEPARTURE: OF r10 <br /> RECEIVED: ` �1 VV <br /> PERSONS AT SCENE <br /> NAME AGENCY PHONE TOA TOD <br /> a a <1� —AL1 <br /> �4-SqM <br /> \1 Yoe _ ►, -0101- <br /> IDENTIFICATION OF MATERIAL(CHEMICAL INVOLVEDy <br /> SUBSTANCE <br /> L D POWDER GAS LIQUID GRANULE <br /> LFORMREFERRALS DATE <br /> TO: J MAILED: <br /> DATE COMPLETED....PROP 9 <br /> 4 C� �( Up <br /> 65: <br /> PERSONS EXPOSED and/or INJURED <br /> NAME ADDRESS PHONE <br /> "PERSONAL TOXIC.SUBSTANCE EXPOSURE.RECORD" COMPLETED? YES NO <br /> ER RECORD MODIFIED Page I of 4 05/01/2007 <br />