Laserfiche WebLink
PqU IN <br /> SAN.JOAO'31N COUNTY <br /> --OFFICE OF EMERGENCY SERVICES" _ S 1J Go GTS <br /> PlanningBtdg_� ept.. <br /> s :. <br /> • oq ��• HAZARDOUS MATERIALS DISCLOSURE SURVEY ..F-178.„'wN0'." - ' "'" '' � <br /> �IFOa <br /> PLEASE PRINT OR TYPE <br /> Q1. Please provide a separate survey for each business name and/or address in San Joaquin County: <br /> a. Business Name: Top Gun Aviation Inc. <br /> b. Business Owner(s) Name: Thomas A. Rouch Phone: 209-983-8082 <br /> C. Facility Address: 6100 S. Lindbergh St. Stockton, Ca . 95206 <br /> d. Mailing Address: Same <br /> e. Nature of Business: Small Aircraft Maintenance Fire District: Montezuma <br /> I. Business Lic. No: 01524 Expires (Mo/Yr) 8-21-9§tandard Indstrl Code No: <br /> g. Proposed Project: <br /> h. if the business is not in operation, when is the approximate date of operation? <br /> 02. Does your business handle a hazardous materiaR 'Hazardous Material' means any material that, because of its <br /> quantity, concentration, or physical or chemical characteristics, poses a significant present or potential hazard to human health and <br /> safety or to the environment if released into the workplace or the environment. (includes fuels, petroleum products, paints, <br /> propane, oxygen, ammonia (AHM), chlorine (AHM), pesticides, fertilizers, and hazardous wastes...). <br /> Yes L'_t No ❑ <br /> 03. If you answered 'YES' to Question 2 above: Do you handle a hazardous material 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 Xl 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 Department). <br /> Yes ❑ No <br /> 05. Will proposed building or modified facility be within 1,000 feet of the outer boundary of a school (grades K-12)? <br /> Yes ❑ No ❑X <br /> I have read the Hazardous Materials Information Guide (on back page) and understand my requirements under Chapter 6.95 of the <br /> California Health and Safety Code Sections 25505, 25533, and 25534. 1 understand that if the building does not currently have a <br /> tenant, that it is my responsibility to notify the occupant of the requirements which must be met prior to issuance of a <br /> Certificate of Occupancy. I declare under the penalty of perjury that this disclosure survey is true and accurate to the best of <br /> my knowledge and is made in the City of Stockton, California. <br /> Owner or Authorized Agent: <br /> (Print) Thomas A. Rouch Tithe General Manager <br /> (Signature) Date 9-18-95 <br /> t. San Joaquin Valley Unified Air Pollutio Tit I tU VV2. ice of Emergency Services <br /> North Region Office II zardous Materials Division <br /> 4230 Kieman Ave., Suite 130 II2 E. Weber Ave., Courthouse-Room 610 <br /> Modesto, CA 95356 (209) 545.7000 Crn O 0% , � ockton, CA 95202 (209) 468-3969 <br /> 24-Hour Telephone: 1.800-281-7003 JC.r O t.T.�l _ <br /> Fax: (209)-545-8652 0 .S INS. DATE <br /> NJD� IN COON Y A PROVE REJECT _ VERIFIED _ <br /> OFFICE OF EM GENCY SERVICES HMMP _ RMPP _ EXEMPT_ V.5.:2 92 <br />