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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 E. Hazelton Ave., Stockton - CA 95205 <br /> (209} 468-3420 - Fax:(209) 468-3433 - Web.www.sigov.org/ehd <br /> - <br /> EMERGENCY RESPONSE RECORD b <br /> DATE: Monday, December 2}4., 2012 SHORTTERM#:CQ003s6 5 <br /> PREMISE ADDRESS: /5b J C` CITY: / <br /> � Vy <br /> DBA: 1P C� � • -coy" LL f CROSS STREET: <br /> PREMISE OWNER: 13/// b S `r D PHONE ,, <br /> OWNER'S ADDRESS: [l0 2 S9.14lo <br /> 9 . CITY: b t` T S 2- ,`0 <br /> FACILITY CONTACT: g — pHO ;� <br /> RESPONSIBLE PARTY(RP)DBA: PG&E <br /> RP NAME: Alex Steele PHONE: (209) 337-8902 <br /> RP ADDRESS: 1108 Murphys Grade Road CITY: Angels Camp <br /> I RP CONTACT: a&11JCPHO E <br /> k <br /> NATURE OF RESPONSE(explosion,spill,leak,fire,or abandoned/dumped material) <br /> I <br /> Spill of 50 gallons transformer oil from PG&E downed power pole. <br /> TIME RECEIVED: 12 noon TIME OF ARRIVAL: TIME OF DEPARTURE: <br /> PERSONS AT SCENE <br /> NAME AGENCY PHONE TOA TOD <br /> e_1 CCAJD U,'. SJC EHD - C/;30 ( U <br /> MATERIAL/CLASSIFICATION(CHEMICAUNVOLVED) <br /> IDENTIFICATION SPILLED? soup LIQUID GAS COMMENTS <br /> {L65} (GAL) ICU FT} <br /> ❑N �b bk -l L�3 <br /> ❑Y oIN <br /> D ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> 13 ❑N <br /> REFERRALS AND NOTIFICATIONS <br /> REFERRED TO(NAME AND ADDRESSS DATE MAILED <br /> j DATE PRO?65 COMPLETED: 2 2 DATE UAR COMPLETED: <br /> IF PERSONS EXPOSED and/or INJURED,"PERSONAL TOXICSUBSTANCE EXPOSURE RECORD"COMPLETED? ❑ YES ❑ NO <br /> ER BINDER COPIES: <br /> SHORT-TERM ON TOP NARRATIVE MAP �ANgLYTICAL DATA PROP 65/UAR ❑ FILE CREATED <br /> —d <br /> MANIFEST ❑ REFERRALS ❑ CLEAN UP REPORT 1 ❑ OTHER AGENCY REPORTS 1 ❑ EXPOSURE RECORD ❑ PHOTOS <br /> I <br /> ER RECORD Page 1 10/03/12 <br /> y <br />