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PUBLIt HEALTH SER110ES <br />SAN JOAQUtN COUNTY %i <br />JOGI KHANNA M.D., M.P.H. , <br />Health Officer <br />C.U. Pox 2009 + (1601 East tlnzelton Avenue) + Stockttm, (:niifornin 95201 <br />(209) 468-3400 <br />EMPROLINCY RPSPONSP Rt?MRD <br />DlsmRtcr 1 <br />PREMISE ADDRESS <br />DIJA t) t IC <br />PREMISE OWNER !qtAL s <br />ADDRESS <br />FACILITY CONTACT r <br />NATURR OF COMPLAINT (explosion, spill, leaky fire, or abandon/dumped tnafetial): tom': <br />TIME RECEIVED ® T7ME OF ARRIVAL A4 2—*j2ryi TIME OF DEPARTURE. <br />(10A) (rob) <br />PERSONS AT SCENE <br />IDENTIFICATION Or MATERIAL (cnEMtcAtiNvomm) <br />SUBSTANCE FORM: I ) SOLID 1) POWDER ( ) (TAS KUOUID I i ORANUll-, <br />REFERRALS 'I'O: L ?�'a DA'T'E MAILED: <br />DATE COMPLETED: PROP 65 —+ UAR ---SC L <br />PERSONS EXPOSED and/ot INJURED <br />NAME ADDRESS NIONE NO. <br />INVESTIGATION REPORT (INCLUDE ttNbiNcs, CLEAN -up RECOMMENOATIONs and <br />t Ldl+nt ( t1.C1 . <br />rt.n 'D a IC_ �#—.,C <br />I71I.E CREATED t l MAP INCLUDED SIIORT-'IV.RM MIM -11131) L4/ ITR FILE copy <br />A Division of San Joagain County I lealth Care Services <br />