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SAN JOAOUIN COUNTY <br /> s AGRICULTURAL:HAZARDOUS MATERIALS <br /> AGRICULTURAL COMMISSIONER <br /> INVENTORX. pasr omice sox 1809 <br /> STOOMN.CALFOFM 96201 <br /> {"iYtf i� PHONE 2W4e&3300 <br /> FAX 2081489'3330 <br /> Part 1: -General Information <br /> Business,Fainn or R-onch Name: site Location i Address(include Zip Code): - No. <br /> Mailing Address_(if different than above): Description of Business Operation(Fein,Nursery,PCO Business,Etc.): Nearest Crossroad: <br /> Emergency Contact Poison: one No. Pesticide Permit!J.D.No: Fire District: <br /> r6�3z -e273 <br /> Part 11: Hazardous Material Information (Refer to the Agricultural Hazard Material Worksheet for the materials that should be listed below) <br /> Max.Number <br /> Container Container Circle the Months iQ on property,i.e.in barn, <br /> Material Name DOT# Type sig Containers On Site NW comer of property,etc. <br /> (at any l time) <br /> op <br /> JFM AM JJ AS OND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND <br /> JFMAMJJASOND * <br /> JFMAMJJASQ; <br /> JPMAMJJASOND <br /> JFMAMJJASOND <br /> WNW <br /> JFMAMJJAS0 <br /> J:PMAMJJASOND <br /> I cutify that this in#brnation is true and cans to the best of MY knowledgr. Additional Inventory Sheets Auachd: <br /> �1—'. 5• dvYes Q No <br /> (Attacb check payable to San Joaquin County or toe payment and return.with�p form a the San Joaquin County Agrniturat Cammissiotur} <br />