Laserfiche WebLink
JUL/12/2017/WED 10:33 AM FAX No, P,001/001 <br />a <br />San Joaquin County <br />Environmental Health Department DDonnaHHoran, REHS <br />1868 E Hazelton Avenue <br />Stockton, California 95205 <br />i <br />IN Website: www.sjgov.org/ehd <br />Phone: (209) 468.3420 <br />Fax: 12091468-3433 <br />111E 12 NV <br />17- 043 z4 - <br />PROGRAM COORDINATORS <br />Does your business handle a hazardous material in any auantity <br />Robert McClellon, REHS <br />Jett Carmesw, REHS, RDI <br />form. <br />Kasey Foley, REHS <br />Does your business generate, treat, or store a hazardous waste in any quantity? (used oil, <br />Linda Turkatte, REHS <br />used antifreeze, waste solvent, etc.) <br />Rodney Estrada, REHS <br />Q2. n Yes xNo <br />Adrienne Ellsgeseer, REHS ° <br />— <br />ST4If NN �D14•US MATERIALS DISCLOSURE SURVEY pl ,r 9 2017 <br />cin ° <br />PERM1� GES �aP urvey form Is required for each business name and/or address in San J gquin County. <br />zgNvl,-+%j1\4pj i,zNTAL HEALTH <br />Business Name: Lowe's FDC #1430 Telephone: 209_51 3W <br />Business Site Address: 512 Luce Ave., Stockton CA 95203 <br />Melling Address (If different from above): <br />Business Owners) Name: Lowe's, HIW Telephone: 704-758-1000 <br />Business owner Address: 1000 Lowe's Boulevard, Mooresville, NO 28117 <br />Nature of Business: Retail Distribution Center Fire District Stockton Fire Department <br />Q1. x Yes o No <br />Does your business handle a hazardous material in any auantity <br />at any one time in the <br />year? See the definition of hazardous material on page 2 of this <br />form. <br />X Yes o No <br />Does your business generate, treat, or store a hazardous waste in any quantity? (used oil, <br />used antifreeze, waste solvent, etc.) <br />If your answer Is "No" to both questions In Of, please print, sign, end date the bottom of this form and return to the address above. <br />Q2. n Yes xNo <br />Does your business 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 feel at <br />any one time in the year? <br />If "Yes", how long have you handled these materials at your business? <br />If "Yes', check any of the following conditions that apply to your business: <br />a A. <br />The hazardous materials handled by this business are contained solely In a consumer <br />product packaged for direct distribution to and use by the general public. <br />o B. <br />This business operates a farm for purposes of cultivating the soil, raising or harvesting an <br />agricultural or horticultural commodity. <br />Q3. o Yes x No <br />Does your business handle an Acutely Hazardous Material? See definition on page 2- <br />Q4. ❑ Yes rx No <br />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 <br />Safety Code (HSC). I understand that if I own a facility or property that is used by tenants, it is my responsibility to notify the <br />tenants of the requirements which must be met prior to issuance of a Certificate of Occupancy or beginning of operations. 1 <br />dedare under the penalty of perjury that the information provided on this disclosure survey Is true and accurate to the best of <br />my knowledge. <br />Owner or Authorized Agent <br />Print Name: Bryan Gadberry Date: 07/0712017 <br />Signature: fyfAa- � 1_ Title: Lowe's Environmental Compliance <br />