My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
SU0013958
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
N
>
99 (STATE ROUTE 99)
>
10150
>
2600 - Land Use Program
>
PA-2100027
>
SU0013958
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
11/19/2024 1:59:09 PM
Creation date
3/17/2021 12:51:26 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
RECORD_ID
SU0013958
PE
2632
FACILITY_NAME
PA-2100027
STREET_NUMBER
10150
Direction
N
STREET_NAME
STATE ROUTE 99
City
STOCKTON
Zip
95212-
APN
08607036
ENTERED_DATE
2/25/2021 12:00:00 AM
SITE_LOCATION
10150 N HWY 99
RECEIVED_DATE
10/13/2023 12:00:00 AM
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\gmartinez
Tags
EHD - Public
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
56
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
2100027 <br />SAN J O A Q U I N Environmental Health Department <br />J. COUNTY <br />y r;i mess 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: Y A h% CCl/ Telephone- 6M 1 1 '� !� 9 <br />Business Site Address: <br />Mailing Address (if different from above): <br />Business Owner(s) Name: U Telephone: � <br />Business Owner Address: <br />Nature of Business: ` Fire District: <br />Q1. ❑ Yes J\lo Does your business handle a hazardous material in any quantity at any one time in the year? <br />See the definition of hazardous materiai on page 2 of this form. <br />o Yes o Does your business generate, treat, or store a hazardous waste in any quantity? (used od, 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. ❑ Yes ❑ 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? <br />If' res", check any of the following conditions that apply to your business: <br />❑ A. 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. ❑ Yes ❑ No Does your business handle an Acutely Hazardous Material? See definition on page 2. <br />Q4. ❑ Yes ❑ 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. -1 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: �y <br />Print Name: SA M, e: <br />Signature: Title: <br />c <br />1868 E., Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com - <br />
The URL can be used to link to this page
Your browser does not support the video tag.