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EHD Program Facility Records by Street Name
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1900 - Hazardous Materials Program
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PR0521167
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COMPLIANCE INFO
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Entry Properties
Last modified
12/5/2018 3:31:38 PM
Creation date
6/10/2018 12:41:14 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1900 - Hazardous Materials Program
File Section
COMPLIANCE INFO
RECORD_ID
PR0521167
PE
1919
FACILITY_ID
FA0001792
FACILITY_NAME
MCDONALDS 25768
STREET_NUMBER
2505
Direction
W
STREET_NAME
MARCH
STREET_TYPE
LN
City
STOCKTON
Zip
95207
APN
11222035
CURRENT_STATUS
01
SITE_LOCATION
2505 W MARCH LN
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
Scanner
JCastaneda
Supplemental fields
FilePath
\MIGRATIONS\M\MARCH\2505\PR0521167\COMPLIANCE INFO.PDF
QuestysFileName
COMPLIANCE INFO
QuestysRecordDate
5/27/2016 4:38:19 PM
QuestysRecordID
3060709
QuestysRecordType
12
QuestysStateID
1
Tags
EHD - Public
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�o COUNTY OF SAN JOAQUIN RECEIVED <br /> q O (� OFFICE OF EMERGENCY SERVICES <br /> '` CI 2101 E. Earhart Avenue, Suite 300 MAR 2 — 2011 <br /> STOCKTON,CA 95206 <br /> o * TELEPHONE(209)953-6200 SAN JOAQUIN COUNTY <br /> R{'F oft FAX:(209)953-6268 OFFICE OF EMERGENCY SERVICES <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 and/or <br /> address in San Joaquin County is required. <br /> Business Name: Telephone: <br /> Business Site Address: 2,505 (n7 , MAR-Cta C A-fJ r- <br /> Mailing Address(if different from above): <br /> Business Owner(s)Name: Telephone: q 2S r 9 4A . 4-OC7 O <br /> Business Owner Address: V_RROl GAIL 'RoAp (WALNVT CFZC, 2 64- g4-sq 7 <br /> Nature of Business: 0 Ut a1� rs <br /> sIT- f E PE-STAU RA t-) I Fire District: <br /> Ql. ❑Yes OIo 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 Mo Does your business handle a hazardous material,or a mixture containing a hazardous material, in a <br /> quantity equal to or greater than 55 gallons, 500 pounds,or 200 cubic feet at 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 applies 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 /> 2B. This business operates a farm for purposes of cultivating the soil,raising,or harvesting an <br /> agricultural or horticultural commodity. <br /> Q3. []Yes ®No Does your business handle an Acutely Hazardous Material? See definition on reverse side of this form. <br /> Q4. []Yes QNo 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 <br /> rreor Authorized Agent: <br /> X M G k%_v PP\it.S Date <br /> linameX Title T'FoSy�T ivlbaNACn Gr <br /> Signature Nev 8/08) <br />
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