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COUNTY OF SAN JOAQ LS y H Vit <br /> OFFICE OF EMERGENCY SERV ../ 1�J <br /> by <br /> ROO„610.COU TwOUSI 1 �) i � and��.N <br /> 222 EAST WEBER AVENUE �'i,i.p gg [�q�j � -'Si.Co.0. �aT DN' <br /> STOCKTON. CALIFORNIA 9520 kBgMiQN STATEMENT "in der. <br /> To,.n la 1: 1 168.3962 ,0313 <br /> X�L.6OOVf MertRuu ansioM 12091/663 9 <br /> SAN)OAQi11N COUNTY <br /> I understand the requirements of Chapter 6.95, Division 20, Section 25500 et seq. of the California <br /> Health and Safety Code which pertains to emergency planning by businesses using hazardous mate- <br /> rials. My business claims the following exemption(s) from the Hazardous Material Management <br /> Plan requirements: <br /> yyIt does not handle a hazardous material,or a mixture containing a hazardous material,in a quantity equal to or <br /> greater than 55 gallons,500 pounds,or 200 cubic feet at standard temperance and pressure for compressed gas <br /> atany one time oran acutely hazardous material in quantities greater than the associated threshold planning quantity. <br /> [] The hazardous material handled by this business is contained solely in a consumer product packaged for direct <br /> distribution to,and use by,the general public(i.e.retail). <br /> (] This business operates a farm for purposes of cultivating the soil or raising or harvesting an agricultural or <br /> horticultural commodity. (ChecUng this box will put your business in the Farm Inventory Program). <br /> [] This business operates a health care facility and uses only medical gases(i.e.doctor,dentist, veterinary...). <br /> (] Other (Describe in detail for review by administering agency). <br /> NameofBusiness 'S C U -, 7-f?--t-k <br /> Nature of Business ~L <br /> Mailing AddressYc � 5 6). Wq Phone(,,)O`)' <br /> City :�"iZ"f .�3 (Q9 Zip <br /> FacilityAddress Phone <br /> City Zip <br /> Nearest intersection of facility site k)/) 2% f Fire District <br /> I swear under penalty offpperjury that thiss statement is accurate to the best of my knowledge. <br /> Owner/Manager \J Gf�:7 I Title (t_2 <br /> C�P=Name <br /> Signature ��� _ , \ Dau ✓2 <br /> `5 — ZZ <br /> 5 <br />