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r , <br /> TASK,.. IiVi71! <br /> • - • MNGRCPT <br /> _. <br /> SAN JOAQUIN COUNTY EJT — - <br /> J�ij � ., REJT <br /> OFFICE OF EMERGENCY SERVICES ENTRY ---_a <br /> ALPHA <br /> " HAZARDOUS MATERIALS SURVEYS --� <br /> PLEASE PRINT OR TYPENAr� <br /> Q1. Please provide a full and complete business name and address for <br /> each site in San Joaquin County. <br /> Business Name: , lt- Iae1i1- ��/ ml�r }ane: <br /> Mailing Address ��\ MfjXr✓ Jr <br /> �J 1 <'Rtreet) <br /> (City) (State) (ZIP) <br /> Facility Address <br /> (Street) <br /> (Cit ) (State) (ZIP) <br /> Contact Person: k,� (-�)L-'PiPhone: <br /> Nature of Business: C-{,46-0jly 6N a-0J1 P1t-11-e-\J7— <br /> Q2. Does/Will your business handle, store or transport hazardous <br /> materials? YES NO 7� <br /> Note: Hazardous materials are defined as "any material that, because of its quantity, <br /> concentration, or physical or chemical characteristics, poses a significant present or potential <br /> hazard to human health and safety or to the environment." Hazardous materials include, but are <br /> not limited to, hazardous substances, hazardous waste, and any material which a handler or the <br /> administering agency has a reasonable basis for believing that it would be injurious to the <br /> health and safety of persons or harmful to the environment if released into the workplace or the <br /> environment. Exam: Oxygen, Acetylene, Carbon Dioxide (CO2), Chlorine, Propane, Diesel, <br /> Gasoline, Motor Oil, Waste Oil, Paint, Cement, Solvent, Ammonia, Lime, Acids, Pesticides ... <br /> Q3. If you answered "YES" to Question 2 above: <br /> Do you handle, store, or transport 55 gallons, 500 pounds, or 200 <br /> cubic feet (at Standard Temperature or Pressure) of a product or <br /> formulation containing hazardous materials at any one time in a <br /> month? YES NO <br /> Name of Company Representative: tom) �3CJN <br /> `--�Jri nt <br /> I� Signature <br /> If you have any questions regarding this survey, please call the Office of <br /> Emergency Services at (209) 944-2116. <br /> 1 .4 <br />