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e I r <br />1. FACILITY IDENTIFICATION <br />BUSINESS NAME 3 <br />FACILITY ID # 1 <br />FIRESTONE COMPLETE AUTO CARE # 3583 <br />FA0006017 <br />SITE ADDRESS 103 <br />CITY 104 <br />ZIP CODE 105- <br />720 EAST HAMMER LANE <br />STOCKTON <br />95210 <br />11. EMERGENCY CONTACTS <br />PRIMARY <br />SECONDARY <br />NAME 123 <br />NAME 128 <br />AMBER DELP <br />MARK MYERS <br />TITLE 124 <br />TITLE 129 <br />STORE MANAGER <br />SERVICE MANAGER <br />BUSINESS PHONE 125 <br />BUSINESS PHONE 130 <br />(209}951-2403 <br />(209)951-2903 <br />24-HOUR PHONE 126 <br />24-HOUR PHONE 131 <br />{916)223-8378 <br />{208}479-1272 <br />PAGER # 127 <br />PAGER # 132 <br />Ill. EMERGENCY RESPONSE PLANS AND PROCEDURES <br />A. Notifications <br />Your business is required by State Law to provide an immediate verbal report of any release or threatened release of a <br />hazardous material to local fire emergency response personnel, this Unified Program Agency (CUPA or PA), and the <br />Office of Emergency Services. If you have a release or threatened release of hazardous materials, Immediately call: <br />FIRE/PARAMEDICS/POLICE/SHERIFF <br />PHONE: 911 <br />AFTER the local emergency response personnel are notified, you shall then notify this Unified Program Agency and the <br />Office of Emergency Services. <br />Local Unified Program Agency: ( 209) 468 - 3420 <br />State Office of Emergency Service: (800) 852-7550 or (916) 262-1621 <br />National Response Center: (800) 424-8802 <br />Information to be provided during Notification: <br />4 Your Name and the Telephone Number from where you are calling. <br />d Exact address of the release or threatened release. <br />d Date, time, cause, and type of incident (e.g. fire, air release, spill etc.) <br />4 Material and quantity of the release, to the extent known. <br />4 Current condition of the facility. <br />4 Extent of injuries, if any. <br />Q Possible hazards to public health and/ or the environment outside of the facility. <br />B. Emergency Medical Facility <br />List the local emergency medical facility that will be used by your business in the event of an accident or Injury <br />caused by a release or threatened release of hazardous material <br />HOSPITAUCLINIC: <br />PHONE NO: <br />KAISER PERMANENTS MEDICAL OFFICES <br />209 476-2000 <br />ADDRESS: <br />7373 WEST LANE <br />CITY: ZIP CODE; <br />STOCKTON, CA 95210 <br />OFFICIAL USE ONLY DATE RECEIVED REVIEWED BY <br />DIV I BN STA OTHER DISTRICT I CUPA PA <br />