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MAY -0e-1995 10.46 STOCKTON PERMIT CENTER. 209+937+ee93 P.01 <br />OFFICE OF EMERGENCY SERVICES <br />PlatiilingBtdg.G-flepC �` ✓ <br />j HAZARDOUS MATERIALS DISCLOSURE SURVEY Fiie ,No: <br />ido'a <br />tat cee:F pgINT OR TYPE � - <br />at. Please provide a separate survey for a= business name and/or address in San Joaquin County: <br />a, Business Name: c; arra Chemical O <br />b. Business Owner(s) NDrne: gt n��=r Phone: 8 <br />C. Facility Address: 1010 Industrial Drive <br />S.ockto CA 95206 <br />d. Mailing Address: Same <br />e. Nature of Business: Chemical Manuf Distrib . Fire Oistrict- <br />f . Business Lic. No: Expires (Mo(Yr) Standard Indstrl Code No: -) A n n <br />g, Proposed Project: Refurbish Bldg./Property for Chemical Facility <br />h. It the business is riot in operation, when is the approximate date of operation? 6 / 1 / 9 5 _ <br />02, Ooes your business handle a 'hazardous materiaR 'ffazardous Material" means any material that, because of its <br />quantity. Concentration, or pftyslcal or chemical characteristics, poses a significant present or potential hazard to human health anC <br />safety or to the environment if released into the workplaca or the environment. (Includes fuels, petroleum products, paints. <br />propane, oxygen, ammonia (AHM), cJifprine (AHM), pesticides. lertilizers, and hazardous wastes__ <br />i( }. <br />Yes t1Sl No !❑ <br />(33. it you answered 'YES' to Question 2 above: 00 you handle a hazardous malenal or a mixture containing a hazardous <br />material in a Quantity equal to or greater than 55 gallons, 500 pounds, or 200 cubic feet at any one time? <br />Yes No ❑ <br />04. Will the owner, applicant or future building occupant handle an Acutely Hazardous Material? (List of Acutely Hazardous <br />Materials available at the Planning Deppriment). <br />Yes ® No <br />45_ Will proposed building or modfied facility be within 1,000 feet of the outer boundary of a school (grades K-12)7 <br />Yes Nq <br />i have read the Hazardous Matariaia l7formatian Gulds (on bath page) and undersUrid my rsquirsdtsnrs under Chapter 5 -FS or rhe <br />California Health and Safety Code Sect/ons 2150S. 25532, and 25574. 1 undersvnd that if rhe building does not currently nave a <br />tenant, that it is my responsibillhIre notify Me occupant of me reQuiremenis which must be mer prior to issuance or a <br />Cerrlfleate of Occupsncr. I decfarc finder rhJ�VC7SLUIlyury that rhis disclosure sin—y is true and accurate to the best of <br />My knowledge and is made In the City of VC: California. <br />Owner or Authorixed Agent: <br />(Printf <br />Stanley K. Kinder, s Pres <br />Sdent <br />Tip <br />oats _ 4/20/95 <br />(Signature) <br />I <br />Sen Joaquin valley Unificd Ale Pollution Control 01st. <br />North Region Olfice <br />4230 Kleman Ave., Suite 130 <br />Modesto, CA 95356 (2" US -7000 <br />24-140ur Telephone: 1-60d-261-7003 <br />Fax: (209)-545-8652 <br />i <br />SAN JOAQUIN UNIFIED APCD <br />APPROVED; <br />BY:,DATE: <br />office at Emergency Services <br />Hazardous Maleriilf olrision <br />222 E. Weber Are.. Ceurthcuse-R otlm 610 <br />Stockton. CI! 25202 (209) •60.3969( <br />OES INSP �'� DATE I�1fJ-1- <br />APPROVF REJECT VERIFIEO , <br />HMUP t RMPP — EXEMPT Y-5.123'92 <br />;ZgMly I <br />MAY o s ffib <br />SAN J(�hQuily VmLLCY <br />UNNO REGION <br />