Laserfiche WebLink
� FILE COPY' <br />PUBLI <br />ALTTJ CS.R. <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DIVISION <br />Ernest M. Fujimoto, M.D., M.P.H., Acting Health Officer <br />304 E. Weber Ave., 3rd Floor • P. O. Boa 388 • Stockton, CA 95201-0388 <br />209/468-3420 <br />DISTRICT # r.. UDATE r�c�� EMERGENCY RESPONSE RECORD <br />_L���� <br />Pp•u�N <br />.P <br />SHORT TERM # x96: <br />PREMISE ADDRESS S`, tv STo <br />r CITY <br />DBA <br />PRE WSE OWNER <br />OWNER'S ADDRESS <br />PHONE lir ) f74 _ ZAjf, <br />FACILITY CONTACT —OGEE <br />NATURE OF COMPLAINT (explosion, —____� ^ PHONE ( 2-g �{ - 7 7�_ <br />,. sP�. k fire, or ab1ndoned/dupped material) <br />TIME RECEIVED ` -7 TIME OF ARRIVAL _ ^?f � ' <br />TIME OF DEPARTURE <br />PERSONS AT SCENE (TOA) (TOD) <br />NAME AGENCY PHONE NO, <br />77/ TOA TOD <br />—_ -- --- .41`t_-!r,1zG <br />IDENTIFICATION OF MATERIAL (CHEMICAL INVOLVED) ..moi' <br />SUBSTANCE FORM: ( j SOLID [ ] POWDER <br />REFERRALS TO: <br />337 <br />[ l GAS faLIQUID [ ] GRANULE <br />DATE MAILED: <br />DATE COWL=: PROP 65 q UAR <br />PERSONS EXPOSED and/or INJURED <br />NAME <br />,re` ADDRESS <br />PHONE NO. <br />rrscavr4AL t UXtG SUBSTANCE EXPOSURE RECORD" COMPLETED? [ 7 YES <br />NO <br />E R. BINDER COPIES: <br />I"KSHORT-TERM ATTACHED ON TOP 0NARRATTVE [ 1 ANALYTICAL DATA <br />'-#Q, PROP 65/UAR <br />[ ] EXPOSURE ,RECORD I l MANIFEST [ j CLEANUP FIRM REPORT [ J OTHER AGENCY REPORTS <br />[ 7 REFERRALS q MAP [ J FII—CREATED <br />A Division of San Joaquin County Health Care Services <br />