Laserfiche WebLink
�� 10•��•CpG , <br /> SAN JOAQUIN COUNTY <br /> ` OFFICE OF EMERGENCY SERVICES <br /> WE `i�n&Bidg <br /> �qt lkoa�'`P HAZARDOUS MATERIALS DISCLOSURE SURVEYt�0 u < <br /> P1 EASPRINT 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 93728 <br /> e. Nature of Business: multi— ur se rocessin , storage an recyc >ng MANTECA LATHROP <br /> P po P g g Fire District: <br /> f. Business Lic. No: Expires (Mohr) Standard Indstrl Code No: <br /> g. Proposed Project:multi—purpose processing, storage and recycling wood andM ste <br /> r nr• c� <br /> h. If the business is not in operation, when is the approximate date of operation? 9/1195 <br /> 02. Does your business handle a hazardous material? "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), chloriinte (AHM), pesticides, fertilizers, and hazardous wastes...). <br /> Yes <br /> El <br /> Yes <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 11 <br /> Q5. 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 /> I 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) Tim A. Weaver President Title President <br /> (Signature) _ ,. Date �3 <br /> 1. San Joaquin Valley Unified Air Pollution Control Dist. 2. Office of Emergency Services <br /> North Region Office Hazardous Materials Division <br /> 4230 Kiernan Ave., Suite 130 222 E. Weber Ave., Courthouse-Room 610 <br /> Modesto, CA 95356 (209) 545-7000 Stockton, CA 95202 (209) 468-3969 <br /> 24-Hour Telephone: 1-800-281-7003 <br /> Fax: (209)-545-8652 OES INSP _ DATE <br /> APPROVE REJECT _ VERIFIED <br /> HMMP — RMPP _ EXEMPT— V.5.12/92 <br />