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COMPLIANCE INFO_PRE 2019
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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E
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88 (STATE ROUTE 88)
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16360
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1900 - Hazardous Materials Program
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PR0520378
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COMPLIANCE INFO_PRE 2019
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Entry Properties
Last modified
11/20/2024 9:21:40 AM
Creation date
6/9/2018 2:17:09 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1900 - Hazardous Materials Program
File Section
COMPLIANCE INFO
FileName_PostFix
PRE 2019
RECORD_ID
PR0520378
PE
1921
FACILITY_ID
FA0006986
FACILITY_NAME
LOCKEFORD SPRINGS GOLF COURSE
STREET_NUMBER
16360
Direction
N
STREET_NAME
STATE ROUTE 88
STREET_TYPE
(none)
City
LODI
Zip
95240
APN
05126033
CURRENT_STATUS
Active, billable
SITE_LOCATION
16360 N HWY 88
P_LOCATION
99
P_DISTRICT
004
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\E\HWY 88\16360\PR0520378\COMPLIANCE INFO 1995- 2012.PDF
QuestysFileName
COMPLIANCE INFO 1995- 2012
QuestysRecordDate
2/24/2016 11:01:45 PM
QuestysRecordID
2994385
QuestysRecordType
12
QuestysStateID
1
Tags
EHD - Public
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oPau IN c - <br /> ' RECEIVED <br /> .G <br /> r <br /> 2007 <br /> OFFICE OF EMERGENCY SERVICE: <br /> COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> Room 610, Courthouse <br /> 222 East Weber Avenue <br /> Stockton, California 95202 <br /> Telephone (209)468-3962 <br /> Hazardous Materials Division (209)468-3969 <br /> HAZARDOUS MATERIALS DISCLOSURE SURVEY <br /> Please read the information on the reverse side before completing this survey form. A separate survey for each business name <br /> and/or address in San Joaquin County is required. <br /> Business Name: ��G"`rt=" �( �✓e 5 e> ��, T �� ✓ <br /> Business Owner(s) Name: Telephone: <br /> Business Address: E76 <br /> Mailing Address(if differentfromabove): 1'�G k�e4o✓4 , 7 <br /> Nature of Business: <�'— Fire District: i "�� �U ✓+ �L <br /> Q1. ❑Yes rNo Does your business handle a hazardous material in any quantity at any one time in the year. See the <br /> definition of hazardous material on the back of this form. If your answer is"No,"go to Question 4. <br /> Q2. ❑Yes LrNo Does your business handle a hazardous material, or a mixture containing a hazardous material in a quantity <br /> equal to or greater than 55 gallons, 500 pounds, or 200c any one time in the year? <br /> If"Yes;how long have you handled these materials at your business? <br /> If"Yes,"check any of the following conditions that apply to your business. <br /> ❑A. The hazardous materials handled by this business is contained solely in a consumer product, packaged for <br /> direct distribution to, and use by,the general public. <br /> ❑B. This business is a health care facility(doctor,dentist, veterinary, etc.)and uses only medical gases. <br /> ❑C. This business operates a farm for purposes of cultivating the soil, raising, or harvesting an agricultural or <br /> horticultural commodity. <br /> Q3. ❑Yes eNNo Does your business handle an acutely hazardous material? See definition on reverse side of this form. <br /> Q4. ❑Yes EJNo Is your business within 1,000 feet of the outer boundary of a school (grades K-12)? <br /> I have read the information on this form and understand my requirements under Chapter 6.95 of the California Health and Safety <br /> Code. I understand that if I own a facility or property that is used by tenants, that it is my responsibility to notify the tenants of the <br /> requirements which must be met prior to issuance of a Certificate of Occupancy or beginning of operations. I declare under the <br /> penalty of perjury that the information provided on this disclosure survey is true and accurate to the best of my knowledge. <br /> Owner or Authorized Agent ' <br /> X -C ✓ 'vC✓"✓e'i Date: <br /> f�/6 7107 <br /> X Title: �iCJ✓It ALL o-Eor <br /> Signature <br /> FB ILDINGV NCCUIWERMMh -COMMERCIAL.DOCFile#125(Rwi5 I0 3LLM) Page 4 of 5 <br />
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