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COUNTY OF SAN JOAP'JIN <br /> OFFICE OF EMERGENCY StiiVICES <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 <br /> name and/or address In San Josquin Courity Is required. <br /> I <br /> Business Name: CHNNrurHAM ERRMS TrNr <br /> Business Owner(s)Name: .g p l i C r ClN K�AW Telephone: 5 9 q_ <br /> Business Address: 2A 47-3--.Sn n u r+ ;6 <br /> Mailing Address(if different from above): <br /> Nature of Business: � i s r n ni r n�r-_�,� r cE Firia'DEStrict: _T R A f_Y FIRE <br /> 0i. OYes Po Does your business handle a hazardous material in any quantity at anyone time in the year? Seethe <br /> definition of hazardous material on the back of this form. If your answer is No,"go to Question 4. <br /> 02. 17Yes ipNo Does your business handle a hazardous material,or a mixture containing a hazardous material In a <br /> quantity equal to or greater than 65 gallons,500 pounds,or 200cubic feet at any one time in the year? <br /> if wYes; <br />