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Dec..729-06 01 : 31P Jacquelyn J . Orr 215 369 5452 P _06 <br /> COUNTY Or SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> Room 610, Courthouse <br /> 222 East Weber Avenue <br /> Stockton, California 95202 <br /> Telephone (208)4611-3962 <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 buslness <br /> name end/or address in Stn Joaquin County Is required. <br /> Business Name: Citadel Broadcasting Company <br /> Business Owner(s)Name: Judy EHIs, COO&Roy Williams Market Manager Tefephone: (209)478-1230 <br /> Business Address: 4843 Ouall Lakes Drive, Stifle 100, Sloddon, CA 95207 <br /> Mailing Address (if different from above): <br /> Nature of Business: Stansmitter Site-Radio Station Fire District: ._W@l4fktg Moradaw <br /> 01. ®Yes ONO Does your business handle a hazardous material In any quantity at any one time In the year? seethe <br /> definition of hazardous material an the back of this form. If your answer Is No,"go to question 4. <br /> 02. MYes r1NO Does your business handle a hazardous material,or a mixture containing a hazardous materiel in a <br /> quantity equal to or greater than 55 gallons,'500 pounds,or 200cubic feet at arty one"me in the year? <br /> If"Yes."how Icrrg have you handled these materiels at your business?New business <br /> If"Yes,'check any of the following conditions that applies to your business. <br /> OA. The hazardous materiels handled by this business Is contained solely in a consumer product, <br /> packaged for direct distribution to,end use by,the general public. <br /> OB. This business is a health care facility(doctor,dentist,veterinary,etc.)and uses 2wy 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 /> 03. OYes MNo Does your business handle an dGutely hazardous materiel? See definition on reverse side of this form, <br /> 04. OYes ®No Is your business within 1,000 rest of the outer boundary of a school (grades K-12)? <br /> 1 have reed the Information on this form and understand my requirements under Chapter 8.95 of the Calltomis Health and <br /> Safety Code. I understand that If t own a facility or property that is used by torrents,that it 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 operetions, <br /> declare under the Penalty of perjury that the Information provided on this disclosure survey is true and accurate to the best <br /> of my knowledge. <br /> Owner or Authorized Agent <br /> X Date: 12n9M6 <br /> PrIn <br /> e <br /> X Tine:_ J <br /> 19, <br /> G <br /> F:bFVaVC1A .I W ADPIC n FwmKBb Approval.IRed6 %Dn Page 6 of 9 <br />