Laserfiche WebLink
RECEIVED BY SJCEHD (EF) on 3/20/20 <br /> °P mac° SAN JOAQUIN Environmental Health Department <br /> COUNTY <br /> cq,.IFO Greatness grows here. <br /> HAZARDOUS MATERIALS DISCLOSURE SURVEY <br /> A separate survey form is required for each business name and/or address in San Joaquin County. <br /> Business Name:Stockton Fence and Material Company Telephone: 209-466-3166 <br /> Business Site Address: 2007 N. Wilson Way Stockton, CA 95205 <br /> Mailing Address(if different from above): 2007 N. Wilson Way Stockton, CA 95205 <br /> Business Owner(s)Name: Philip D. Beghtel Telephone: 209-981-6083 <br /> Business Owner Address: 10018 Freesia Ave. Stockton, CA 95212 <br /> Nature of Business: Fencing Construction Company Fire District: Fire Station Number 9 <br /> Q1. EXYes ❑ No Does your business handle a hazardous material in any quantity at any one time in the year? <br /> See the definition of hazardous material on page 2 of this form. <br /> ❑Yes C No Does your business generate,treat,or store a hazardous waste in any quantity?(used oil,used <br /> antifreeze,waste solvent, etc.) <br /> If your answer is"No"to both questions in Q1,please print,sign,and date the bottom of this form and return to the address above. <br /> Q2. EXYes ❑ No Does your business handle a hazardous material,or a mixture containing a hazardous material, <br /> in a quantity equal to or greater than 55 gallons, 500 pounds, or 200 cubic feet at any one time <br /> in the year? <br /> If"Yes", how long have you handled these materials at your business?Approx.Aug 2019 <br /> If"Yes", check any of the following conditions that apply to your business: <br /> rKA. The hazardous materials handled by this business are contained solely in a consumer product <br /> packaged for direct distribution to and use by the general public. <br /> ❑ B. This business operates a farm for purposes of cultivating the soil, raising or harvesting an <br /> agricultural or horticultural commodity. <br /> Q3. g�Yes ❑ No Does your business handle an Acutely Hazardous Material? See definition on page 2. <br /> Q4. i_XYes ❑ No 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 Safety <br /> Code(HSC). I understand that if I own a facility or property that is used by tenants, it is my responsibility to notify the tenants of the <br /> requirements which must be met prior to issuance of a Certificate of Occupancy or beginning of operations. I declare under the <br /> penalty of perjury that the information provided on this disclosure survey is true and accurate to the best of my knowledge. <br /> If you answered"Yes"to Question 2, please go online to cers.calepa.ca.gov to submit your hazardous materials information. <br /> Owner or Authorized Agent: <br /> Print Name:Randi Sue Beghtel Date: 03/18/2020 <br /> Digitally signed by Randi Sue <br /> Signature: Randi Sue B2ght2I Beghtel Title: Office Administrator <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />