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... -- 0 0 <br />�, o� SAN .7OAQUIN ®LINTY <br />/ ENVIRONMENTAL HEALTH DEPARTMENT <br />x m� 1868 E. Hazelton Ave., Stockton • CA 95205 <br />(209) 468-3420 • Fax (209) 468-3433 •Web; www.sjgov.org/ehd <br />EMERGENCY RESPONSE RECORD <br />DATE: Tuesday, April 8, 2014 <br />SHORT TERM#: ?il <br />PREMISE ADDRESS: 6633 Pacific Avenue <br />CITY: Stockton <br />DBA: CHEVRON STATION #96171 * <br />CROSS STREET: Ben Holt <br />PREMISE OWNER: CHEVRON <br />PHONE: <br />OWNER'S ADDRESS: PO BOX 6004 / L2375 -B3, <br />CITY:San Ramon <br />FACILITY CONTACT: Gerardo Acuna <br />PHONE: 925-766-6939 <br />RESPONSIBLE PARTY (RP) DBA: `See Above <br />RP NAME: <br />PHONE: <br />RP ADDRESS: <br />CITY: <br />RP CONTACT: <br />PHONE: <br />NA I URL OF RESPUNSt (explosion, spill, leak, tire, or abandoned/dumped material) <br />Approximately 3 gallons of supreme fuel was released during fuel transfer from the tanker truck to the <br />underground storage tank <br />TIME RECEIVED: 4.06 pm I TIME OF ARRIVAL: 5:11 pm I TIME OF DEPARTURE: 5.21 pm <br />PERSONS AT SCENE <br />NAME <br />AGENCY <br />PHONE <br />TOA <br />TOD <br />Elena Manzo <br />SJC END <br />(209) 953-7699 <br />3 <br />No water impact <br />o o <br />o o <br />o ❑N <br />o o <br />MATERIAL/CLASSIFICATION (CHEMICAL INVOLVEDI <br />IDENTIFICATION <br />SPILLED? <br />SOLID <br />(LBS) <br />LIQUID <br />(GAL) <br />GAS <br />(CU FT) <br />COMMENTS <br />Supreme fuel <br />XY ❑ N <br />3 <br />No water impact <br />o o <br />o o <br />o ❑N <br />o o <br />o o <br />REFERRALS AND NOTIFICATIONS <br />REFERRED TO (NAME AND ADDRESS) DATE MAILED <br />DATE PROP 65 COMPLETED: 4-8-2014 DATE LIAR COMPLETED: <br />IF PERSONS EXPOSED and/or INJURED, "PERSONAL TOXIC SUBSTANCE EXPOSURE RECORD" COMPLETED? ❑ YES ❑ NO <br />X SHORT-TERM ON TOP X NARRATIVE I X MAP 1 ❑ ANALYTICAL DATA I X PROP 65 / LIAR o FILE CREATED <br />❑ MANIFEST ❑ REFERRALS 1 ❑ CLEANUP REPORT 1 ❑ OTHER AGENCY REPORTS 1 ❑ EXPOSURE RECORD XQ PHOTOS <br />ER RECORD Page 1 10/03/12 <br />