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San Joaquin County DIRECTOR <br /> Donna Heran,REHS <br /> O,.PqurN -C Environmental Health Department ASSISTANT DIRECTOR <br /> 600 East Main Street Laurie Cotulla,RENS <br /> Stockton, California 95202-3029 <br /> PROGRAM COORDINATORS <br /> Carl Borgman,REHS <br /> Mike Huggins, REHS,RDI <br /> Website: www.sjgov.org/ehd Margaret Lagorio,REHS <br /> L <br /> I .;0¢ Phone: (209)468-3420 Robert McClellon,REHS <br /> Fax: (209)464-0138 Jeff Carruesco,REHS, RDI <br /> EMERGENCY RESPONSE RECORD Kasey Foley,REHS <br /> DATE: U $ SHORT TERM#: Co O 2 -7-7 2 - , <br /> PREMISE ADDRESS: Z LiV i 1 E . O D Q f Qt _ c1TY: E�t L <br /> DBA: 5 r i`r' <br /> PREMISE OWNER: PHONE: <br /> OWNER'S <br /> /� <br /> OWNER'S ADDRESS: _� �,()�1�7 S 2� G�C q'1lSA1 L RJ "/mac:3 ?•D <br /> FACILITY CONTACT: PHONE: <br /> RESPONSIBLE PARTY(RI)!DBA: P. 'f p <br /> RP NAME: LA 1 G�VA- Lam— PHONE: L <br /> RP ADDRESS: P. D + RDV� <br /> RP CONTACT: PHONE: <br /> NATURE OF COMPLAINT(explosion, spill, leak, fire, or abandoned/dumped material) <br /> Cs1' N�►,.►- P c-� b r L <br /> - r <br /> TIME RECEIVED: : n TIME OF ARRIVAL: �� a� TIME OF DEPARTURE: Z �� <br /> PERSONS AT SCENE <br /> NAME AGENCY PHONE TOA TOD <br /> jJ 9-4-- - <br /> IDENTIFICATION OF MATERIAL ca+Eweu.wvocvsm <br /> SUBSTANCE FORM ❑SOLID ❑ POWDER ❑ GAS LIQUID []GRANULE <br /> REFERRALS TO: DATE MAILED: <br /> DATE COMPLETED........PROP 65: UAR: <br /> PERSONS EXPOSED and/or INJURED <br /> NAME ADDRESS PHONE <br /> "PERSONAL TOX/C SUBSTANCE EXPOSURE RECORD" COMPLETED? ❑ YES CjCNO <br /> 9 R. DE TE <br /> SHORT-TERM ON TOP NARRATIVE ANALYTICAL DATA PROP 65/ UAR <br /> 10 <br /> EXPOSURE RECORD MANIFEST ❑ CLEAN UP REPORT Lj OTHER AGENCY REPORTS <br /> ❑ REFERRALS ER MAP ❑ FILE CREATED <br /> Document! Pave: i of 6/14/1999 <br />