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006 <br /> py V!jV o <br /> SAN.IOAQUIN COUNTY <br /> OFFICE=OF THE <br /> " a <br /> AGRICULTURAL HAZARDOUS MA'T'ERIALS <br /> ayp(�WT�pJ]��y7I�V7��■1a/�a ��/} AGRICULTURAL COMMISSIONER <br /> POST OFFICE=SOX 18w <br /> STOCKTON CALIFORNIA 95201, <br /> PHONE20914fi833pa <br /> fit!F pR� <br /> FAX 2091468-3330 <br /> Part I: General Information <br /> Business,Farm or Ranch Name: Site Locations,/Address(include Zip Code): Phone.No: <br /> Mailing Address(if different than above): Description of Business I Operation{Farm,Nursery,PCO Business,Etc.): Nearest,Crossroad: <br /> 'C Emergency ContactP.ersen: 4 Phone No : Pesticide Permit/L D,No: . F eDistnct:. <br /> Part II: Hazardous Material Information efer to the Awicultural Ik and Material:Workshat for the materials that should be listed Below) <br /> Material Name . DOT# Container 1,.Contalnff Max.Nwt ber Circle the Months Locations do pioperty,i.e.m;M7. <br /> Type , .. Size Containers cit Site ltiw C6MPT g%prcaiy,ULU- <br /> JFMAMJJASOND <br /> d <br /> JFMAMJJASOND <br /> JFMAMJJ. SO <br /> JFMAMYJAS4ND - ' <br /> � .. <br /> JFMAMJJASOND <br /> J.FMAMJJA;keW ..; "X <br /> XTON <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> 1.01 ceA4 that I do not-store hazardous nixterials in reportable qunttties (no fee required): <br /> 2.❑I certify that there is.no.change in the hazardous material information last filed-wW the"San Joaquin County Agricultural Cominzssioner(fee required): <br /> 3,[:1I certify that the above hazardous material information is.true,and comet tolthe.best of arty knowledge{fee required); Addttiona]Inv tory_Sheets Attached: <br /> Name(please print) Date <br /> (Attach check pa;rablo to San Joaquin County for fee payment and;eturn'with coryleted fornt to the San Joaquin County Agricultural Cotninissioner) (rev.11197) <br />