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San Joaquin County DIRECTOR <br /> oP " .C, Environmental Health Department Donna Heran, RENS <br /> ASSISTANT DIRECTOR <br /> 600 East Main Street Laurie Cotulla,RENS <br /> } j '{ Stockton, California 95202-3029 PROGRAM COORDINATORS <br /> Ll�L�'` c <br /> Carl Sorgman,REHS <br /> c.• p Mike Huggins,REHS, RDI <br /> 9� pRrig Website: www.sjgov.org/ehd Margaret Lagorio, REHS <br /> Phone: (209)468-3420 Robert McClellon,REHS <br /> Fax: (209)464-0138 Jeff Carruesco, REHS, RDI <br /> p� EMERGENCY RESPONSE RECORD Kasey Foley,REHS <br /> DATE: L'L 2 I L) A /� SHORT TERM#: C U oc>3 13 5 <br /> PREMISE ADDRESS: <br /> ADDRESS: 313 r 4-_ "L� h. CITY: (S <br /> V «�6�I <br /> DBA: S los�n Ser U)4. <br /> PREMISE OWNER: PHONE: <br /> OWNER'S ADDRESS: 11�� T <br /> FACILITY CONTACT: DI)yjN k I PHONE: f7� �g 6 <br /> RESPONSIBLE PARTY(RP)DBA: 0102r, S 0� 044i <br /> �h 14I f! C4(-kVk-,— <br /> RP NAME: s k/o lt_ PHONE:(2,15) 612 75 <br /> RP ADDRESS: p• b <br /> RP CONTACT: PHONE: <br /> NATURE OF COMPLAINT(explosion, s ill, leak, fire, or abandoned/dumped material) /I <br /> A �- r V�-i� Itirj?A c.-L. f jint V r c4-G L+,aj Arf ✓'"'1 ►'�/�► <br /> C a �-Gl �S til <br /> TIME RECEIVED: I TIME OF ARRIVAL: I T t S� TIME OF DEPARTURE: <br /> PERSONS AT SCENE <br /> NAME AGENCY PHONE TOA TOD <br /> ��►+-y� �o rzrS �l US �'S �I83-LL�b — <br /> R��h Shy Fih. Cosnn�l, <br /> IDENTIFICATION OF MATERIAL(I..CAL V.LVE., <br /> SUBSTANCE FORM ❑SOLID ❑ POWDER ❑ GAS LIQUID ❑GRANULE <br /> REFERRALS TO: DATE MAILED: <br /> DATE COMPLETED........PROP 65: 1 1, Za1 D 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 /> SHORT-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: t of 6/14/1999 <br />