Laserfiche WebLink
San Joaquin County DIRECTOR <br /> Donna Heran,RENS <br /> p. �u+, •.0 Environmental Health Department <br /> F' ASSISTANT DIRECTOR <br /> 600 East Main Stree# <br /> 2. Laurie CotuAa,RENS <br /> a ,V, t2� a <br /> Stockton, California 95202-3029 PROGRAM COORDINATORS <br /> .'• Carl Borgman, REHS <br /> Website: www. ov or ehd Mike Huggins,RENS, RDI <br /> 0. ';A si 1J 9� Margaret Lagorio, REHS <br /> Phone: (209)468-3420 Robert McClellon,RENS <br /> Fax: (209)464-0138 ,teff Carruesco, RENS, RDI <br /> EMERGENCY RESPONSE RECORD Kasey Foley, REHS <br /> DATE: to 11L4 m6 SHORT TERM#: �Q��2 O <br /> PREMISE ADDRESS: - A DfLu 10,4 U)�. CITY: L b T,/n <br /> DBA: G U �nn f .L r-C <br /> Y Co �p <br /> PREMISE OWNER: 6� 4 n I PHONE: <br /> OWNER'S ADDRESS: S$�"�. 9OV' <br /> FACILITY CONTACT: 6` '4 a PHONE: <br /> RESPONSIBLE PARTY(RP)DBA: C� n 1 '► <br /> RP NAME: V eor pP�HONE: � — c <br /> _ <br /> RP ADDRESS: 45-)1-,' A�&+1 LA W' r C� � 16 9 <br /> RP CONTACT: PHONE: <br /> NATURE OF COMPLAINT(explosion, spill, leak, fire, or abandoned/dumped material) <br /> k. �? r G�yY fis"��Say tt 0 6Gtt'r". 41- ,U '. p <br /> 1 <br /> TIME RECEIVED: f r TIME OF ARRIVAL: 12 i{Z TIME OF DEPARTURE: <br /> T <br /> PERSONS AT SCENE <br /> NAME AGENCY PHONE TOA TOD <br /> C VIA <br /> Dream ��� <br /> IDENTIFICATION OF MATERIAL ICHEWCAL INVOLVEDr <br /> SUBSTANCE FORM [:] SOLID ❑ POWDER ❑ GAS VLIQUID []GRANULE <br /> REFERRALS TO: � DATE MAILED: <br /> E <br /> DATE COMPLETED........PROP 65: ! L <br /> f" b UAR: <br /> PERSONS EXPOSED and/or INJURED <br /> NAME ADDRESS PHONE <br /> "PERSONAL TOXIC SUBSTANCE EXPOSURE RECORD" COMPLETED? ❑ YES NO <br /> E.R. BINDER COPIES: <br /> VSHORT-TERM ON TOP NARRATIVE ❑ ANALYTICAL DATA PROP 65/UAR <br /> EXPOSURE RECORD MANIFEST ❑ CLEAN UP REPORT OTHER AGENCY REPORTS <br /> ❑ REFERRALS MAP ❑ FILE CREATED <br /> Documentl Page: l of3 6!14/1999 <br />, i <br />