Laserfiche WebLink
��000 �. �.o . <br /> �Pauty` San Joaquin County plRecTOR <br /> ��t,c� Environmental Health Department Donna Haran.REH3 <br /> '' 1888 E Hazelton Avenue <br /> / StocKton, California 95205 f+RocRnm cooaowaroRa <br /> Robert MCClellon.REHS <br /> Jeff Canua6c0.RENS.ROI <br /> �"�. � Kasay Foley.REHB <br /> X5='2= `�,, WabBlta: WWW,aJ90V.Or9/ahfj Llntla Turkatte,REHS <br /> Phone: (209)468-3420 Rodney Estrace.REHS <br /> Fax: (209)466-3433 Atlnenna Eua9essar,REHS <br /> HAZARDOUS MATERIALS DISCLOSURE SURVEY <br /> A separate survey form is required£or each business name antl/or atltlress In Sen Joaquin County. <br /> Business Name: Premier Finishing Telephone: (209) 982-5585 <br /> Business Slte Address: 79'10 Longe Street, Stockton, CA 95208 <br /> Mailing Address(if different from above): <br /> Business Owners)Nama: Craig Walters Telephone: (209) 982-5585 <br /> Business owner Address: 791 O Longe Street, Stockton, CA 95208 <br /> Na[ura of Bueinesa: Fire District iMa r✓ ^j'g .Z u ...�.T— <br /> Q1. o Vee �o Does your business hantlle a hezartlous materiel 'n envguan£N at any one Time in Iha <br /> yeary Sea the tlafinition of hezartlous material on page 2 of chis form. <br /> o Yas � Does your business generate,treat,or store a hezartlous waste'n antiNl(usetl oil, <br /> usetl antifreeze,waste solvent, etc.) <br /> If your antiwar Is"No"!o both quaatlona In 01,please print,at9n.and tlata the bottom aT ttrla form and return to the atldreaa above. <br /> p2. o Yes Y✓Flo Does your business handle a hazardous material, ora mixture containing a hazertlous <br /> material, in a quantity equal to or greater than 55 gallons. 500 pountls, or 200 cubic feet at <br /> any one time In the year9 <br /> If"Yes", how long have you hantlletl these materials at your business? <br /> If"Yes",chalk any of the£ollowin9 conditlona that apply to your bunina¢a: <br /> o A. Ther hazertlous materials handled by tM1ia buainass a ontainad solely in a consumer <br /> protluc[peckagetl for direct distribution to and use by the general public. <br /> o B. This buainass operates a faun for purposes of culSivating the soil, raising or harvesting en <br /> agricultural or horticultural commodity. <br /> Q3. o Vas r� Does your business hantlle an Acutely Hazartloua Matarial7 Sea definition on page 2. <br /> Q4. o Yes a� la your business within'1,000 feet of the outer bountlary of a school?(Gredea K-22) <br /> I have read the Information on this form antl understantl my requirements untlar Chapter f3.95 of the Celifomia Heel[h antl <br /> Safa[y Cotler(HSC). I understand that if I own a facility or property[het Is usetl by tenants, It is my responsibility to no[Ify the <br /> tenants of the requirements which must be ma[prior to issuance of a Certificate of Occupancy or beginning of operations. I <br /> declare untlar the penalty of perjury tM1at[he information provitletl on tM1is tlisclosure survey Is true antl accurate So the beef of <br /> my knowledge. <br /> Owner or Authorizatl AgenT. <br /> Print Name: C�V'i V'r `+_- LT"� Date: � ( �/ay�� <br /> Bignature: „/IrL'��— Title: tyre-s t��— <br />