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aPQU,�k•.c SAN JOAQUIN COUNTY <br /> OFFICE OF THE <br /> AGRICULTURAL HAZARDOUS MATERIALS AGRICULTURAL COMMISSIONER <br /> INVENTORY f i1NTORY POST OFFICE BOX 1809 <br /> STOCKTON CALIFORNIA 95201 <br /> C�q�f F piia;P PHONE 20914683300 <br /> FAX 2091468-3330 <br /> Part I: General Information <br /> Business,Farm or Ranch Name: Site Locations/Address(include Zip Code): Phone No: <br /> r T f 97 W �lR9-. :cs C s�3o.- 7. f—9 Y`7 <br /> Mailing Address(if different thAD above): Description of Business/Operation(Farm,Nursery,PCO Business,Etc.): Nearest Crossroad, <br /> YU Y ci A-(-mo4) �c , <br /> i'Emergency Contact Person: Phone No: Pesticide Permit/L D.No: Fire District: <br /> P0-7,P-q3�7 <br /> S�LRJI T S' -j(0 P,-, <br /> Part II: Hazardous Material Information(Refer to the Agricultural Hazard Material Worksheet for the materials that should be listed below) <br /> �rfe��l r T.— DOT# Container Container Max.Number Circle the Months Locations on property,i.e.in barn <br /> �...... <br /> Type Size Containers On Site N w comer of property,etc. <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> 1.5,I certify that I do not store hazardous materials in reportable quantities(no fee required): <br /> 2.❑I certify that there is no change in the hazardous material information last filed with the San Joaquin County Agricultural Commissioner(fee required): <br /> 3.[]l certjfy that the 0ove hazardous material information is true and correct to the best of my knowledge(fee required): Additional Inventory Sheets Attached: <br /> 024DD p p <br /> I <br /> Yes No <br /> Sigma Name(please print) Date <br /> (Attach check payable to San Joaquin County for fee payment and return with completed form to the San Joaquin County Agricultural Commissioner) (mv.11/97) <br />