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OCT/10/2017/TUE 07:07 AM FAX No. P,001/001 <br />RECEIVED <br />OCT i 0 2011 <br />t y San Joaquin County <br />aped. ONMENTME��Niental Health Department <br />L; <br />DEPARTMENT 1868 E Hazelton Avenue <br />Stockton, California 95205 <br />Webaite: www.sjgov.org/ehd <br />Phone: (209) 468-3420 <br />Fax: (209) 468-3433 <br />DIRECTOR <br />Donna Heran, REHS <br />PROGRAM COORDINATORS <br />Robert McClellon, REHS <br />Jell Camresoo, REHS, RDI <br />Kaley Foley. REHS <br />Linda Turka le, REHS <br />Rodney Estrada, REHS <br />Adrienne Elisaessar, REH5 <br />HAZARDOUS MATERIALS DISCLOSURE SURVEY <br />A separate survey form is required for each business name and/or address in San Joaquin County. <br />Business Name: MCKINNEY TRAILER RENTALS Telephone: 209-466-1070 <br />Business site Address; 1021 S STOCKTON ST STOCKTON 95206 <br />Mailing Address (if different from above): SAME <br />Business Owner(s) Name: PAUL GAUDREAU_ Telephone: _209-066-1070 <br />Business Owner Address: <br />Nature of Business TRAILER RENTALS/SALES Fire District STOCKTON <br />O1. o Yes XNo Does your business handle a hazardous material In any ousntity at any one time in the <br />year? See the definition of hazardous material on page 2 of this form. <br />o Yes XNo Does your business generate, treat, or store a hazardous waste in any civantlty? (used oil, <br />used antifreeze, waste solvent, etc.) <br />If your answer Is "No" to both questions In 01, plaaaa print, sign, and date the bottom of this form and return to this address above. <br />Q2 o Yes o No Does your business handle a hazardous material, or a mixture containing a hazardous <br />material, in a quantityequal to or greater than 55 gallons, 500 pounds, or 200 cubic feet at <br />any one bme 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 />o A. The hazardous materials handled by this business are contained solely in a consumer <br />product packaged for direct distribution to and use by the general public. <br />o B, This business operates a farm for purposes of cultivating the soil, raising or harvesting an <br />agricultural or horticultural commodity, <br />03. o Yes o No Does your business handle an Acutely Hazardous Material? See definition on page 2. <br />Q4. D Yes o No Is your business within 1,000 feat 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 <br />Safety Code (HSC). I understand that if I own a facility or property that is used by tenants, k is my responsibility to notify the <br />tenants of the requirements which must be met prior to issuance of a Certificate of Occupancy or beginning of operations. I <br />declare under the penalty of perjury that the information provided on this disclosure survey is true and accurate to the best of <br />my knowledge. <br />Owner or Authorized Agent: <br />Print Name: 900L BAUSINGER <br />Signature: <br />fl IIMM <br />9/15/17 <br />Title: COMPLIANCE MGR <br />