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0 " •� 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.sjgov.org/ehd <br /> EMERGENCY RESPONSE RECORD <br /> DATE: Monday, May 29, 2017 COC6AYWBX <br /> SHORT TERM#: <br /> PREMISE ADDRESS: In front Of 1025 N West Lane, at entrance to Bear Creek CITY:Stockton <br /> DBA:N/A CROSS STREET:Morada Lane <br /> PREMISE OWNER:COunty ROW PHONE: <br /> OWNER'S ADDRESS: CITY; <br /> FACILITY CONTACT: PHONE: <br /> RESPONSIBLE PARTY(RP)DBA:Unknown <br /> RP NAME: PHONE: <br /> RP ADDRESS: CITY: <br /> RP CONTACT: PHONE: <br /> NATURE OF RESPONSE(explosion,spill,leak,fire,or aba ndoned/dumped material) <br /> Abandoned container. <br /> TIME RECEIVED:1441 TIME OF ARRIVAL: 1515 TIME OF DEPARTURE: 1605 <br /> PERSONS AT SCENE <br /> NAME AGENCY PHONE TOA TOD <br /> Robert Lopez SJC EHD 2099536214 1515 1605 <br /> MATERIAL/CLASSIFICATION(CHEMIUONV ED) <br /> IDENTIFICATION SPILLED7 SOLID LIQUID GAS COMMENTS <br /> ILM) (GAL) ICU FT) <br /> Combustible liquid D Y x N 15 Transferred from fuel tank to drum <br /> DY ❑N <br /> DY DN <br /> DY DN <br /> DY DN <br /> DY DN <br /> REFERRALS AND NOTIFICATIONS <br /> REFERRED TO(NAME AND ADDRESS) DATE MAILED <br /> DATE PROP 65 COMPLETED: DATE LIAR COMPLETED: <br /> IF PERSONS EXPOSED and/or INJURED,"PERSONAL TOXIC SUBSTANCE EXPOSURE RECORD"COMPLETED? D YES D NO <br /> ER BINDER COPIES: <br /> X SHORT-TERM ON TOP �( NARRATIVE X MAP D ANALYTICAL DATA D PROP 65/UAR D FILE CREATED <br /> D MANIFEST D REFERRALS D CLEAN UP REPORT I X OTHER AGENCY REPORTS D EXPOSURE RECORD I X PHOTOS <br /> ER RECORD Page 1 10/03/12 <br />