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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> Room 610, Courthouse <br /> 222 East'WeberAvenue <br /> Stockton, California 95202 <br /> Teiephone,,(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 Joaquin County Is required. <br /> Business Name: Leonard & Co . Inc . <br /> BuslnessOwner(s) Name: / Fred Wilhelm President Telephone: 408-938-3740 <br /> Business Address: 2001 Tarob Court Milpitas , Ca . 95333 <br /> Mailing Address (if different from above): <br /> Nature of Business: _ADVERTISING Fire District: <br /> Q1. ❑Yes R No Does your business handle a hazardous material In any quantity at any one time In the <br /> year? See the definition of hazardous material on the back of this form. If your answer is <br /> No;go to Question 4. <br /> Q2. ❑Yes 12 No Does your business 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 200cubic feet at <br /> 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 /> OA. The hazardous materials handled by this business is contained solely in a consumer product, <br /> packaged for direct distribution to, and use by,the general public. <br /> OB. This business is a health care facility(doctor, dentist,veterinary, etc.) and uses only medical gases. <br /> OC. This business operates a farm for purposes of cultivating the soil, raising, or harvesting an <br /> agricultural or horticultural commodity. <br /> Q3 OYes YNo Does your business handle an acutely hazardous material? See definition on reverse <br /> side of this form. <br /> Q4. OYes 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 <br /> Safety Code. 1 understand that If I own a facility or propertythat Is used by tenants,that it Is my responsibility to notify the <br /> tenants of the requirements which must be mel 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 /> X eo io Perry Date10-14-04 <br /> Print Nam <br /> x rue: .. Sire r e D p- <br /> 'Ignature T� vc�FSe- 8usir ment <br />