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SAN JOAQUIN COUNTY <br />OFFICE OF EMERGENCY SERVICES <br />HAZARDOUS MATERIALS DISCLOSURE SURVEY <br />IT OR TYPE <br />01. Please provide a separate survey for each business name and/or address in San Joaquin County: <br />a. Business Name: Weaver Industries, Inc. <br />b. Business Owner(s) Name: Weaver Industries, Inc. Phone:(209) 486-8733 <br />C. Facility Address: 2801 E. Louise Avenue <br />Manteca, CA <br />d. Mailing Address: Weaver Industries, Inc.; 1380 N. Hulbert Avenue; Fresno, CA 9372€ <br />, <br />e. Nature of Business: multi—purpose �rocessing g Firstorage it recyc Ing MANTECA LATHRC <br />e District: <br />f. Business Lic. No: Expires (Mo/Yr) Standard indstri Cade No: <br />g- Proposed Project:multi—purpose processing, storage and recycling wood and gonrW,�iS�tE <br />h. if the business is not in operation, when is the approximate date of operation?g/1 /95 <br />02. Does your business handle a hazardous materiae "Hazardous Material" means any material that. because of its <br />quantity, concentration, or physical or chemical characteristics, poses a significant present or potential hazard to human health and <br />safety or to the environment if released into the workplace or the environment. (includes fuels, petroleum products, paints, <br />propane, oxygen, ammonia (AHM), chlorine (AHM), pesticides, fertilizers, and hazardous wastes...). <br />Yes ❑ No 124 <br />03. If you answered "YES" to Question 2 above: Do you handle a hazardous material or a mixture containing a hazardous <br />material in a quantity equal to or greater than 55 gallons, 500 pounds, or 200 cubic feet at any one time? <br />Yes ❑ No ❑ <br />04. Will the owner, applicant, or future building occupant handle an Acutely Hazardous Material? (List of Acutely Hazardous <br />Materials available at the Planning Department). <br />Yes ❑ No 13 <br />05. Will proposed building or modified facility be within 1,000 feet of the outer boundary of a school (grades K-12)? <br />Yes ❑ No <br />1 have read the Hazardous Materials Information Guide (on back page) and understand my requirements under Chapter 6.95 of the <br />California Health and Safety Code Sections 25505, 25533, and 25534. 1 understand that if the building does not currently have a <br />tenant, that it is my responsibility to notify the occupant of the requirements which must be met prior to issuance of a <br />Certificate of Occupancy. i declare under the penalty of perjury that this disclosure survey Is true and accurate to the best of <br />my knowledge and is made in the City of Fresno . California. <br />Owner or Authorized Agent: <br />(Print) Weaver, President Title President <br />,z3 <br />(Signature) �liLiC.� Date <br />1. San Joaquin Valley Unified Air Pollution Control Dist. <br />North Region Office <br />4230 Kiernan Ave., Suite 130 <br />Modesto, CA 95356 (209) 545-7000 <br />24 -Hour Telephone: 1-800-281-7003 <br />Fax: (209)-545-8652 <br />2. Office of Emergency Services <br />Hazardous Materials Division <br />222 E. Weber Ave., Courthouse -Room 610 <br />Stockton, CA 95202 (209) 468-3969 <br />DES INSP _ DATE —/—L <br />— <br />APPROVE REJECT _ VERIFIED _ <br />HMMP — RMPP — EXEMPT_ V.5.12/92 <br />