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PA - 0300229 ,a� H COUNTY OF SAN JOAQUIN o. .co OFFICE OF EMERGENCY SERVICES RONALD E.BALDtl'IN ROOM 610,COURTHOUSE DIRECTOR OF m: i< 222 EAST WEBER AVENUE EMERGENCY OPERATIONS STOCKTON,CALIFORNIA 95202. _ ��® ciFpp TELEPHONE(209)468-3962 F17� , -HAZARDOUS MATERIALS DIVISION(209)468-39`§69. HAZARDOUS MATERIALS DISC SURE SURVVEY JUL —7 2003 0€ss McENCYS VICE Please read the information on the reverse side before completing this survey form. A separate survey for each usiness na e and/or address in San Joaquin County is required. Business Name: TOTE—A—SHED, INC. he 1V(�qzQQ 0 Business Owner(s)Name: Robert Hill Telephone: 800 .423.8683 Business Address: 2701 So. Hwy 99 Stockton, CA . Mailing Address(if different from above): 348 Phelan Ave San. Jose, CA 95112 Nature of Business: storage. containers Fire District: Ql. [/�4_es ONO Does your business handle a hazardous material in any quantity at any one time in the year? See the ` // definition of hazardous material on the back of this form. If your answer is "No",go to Question 4. Q2. 7—Yes *0 Does your business handle a hazardous material,or a mixture containing a hazardous material,in a \\ quantity equal to or greater than 55 gallons,500 pounds,or 200 cubic feet at any one time in the year? If"Yes";how long have you handled these materials at your business? ' If "Yes",check any of the following conditions that applies to your business?. G A. The hazardous materials handled by this business is contained solely in a consumer product packaged for direct distribution to,and use by,the general public. ❑ B. This business is a health care facility(doctor,dentist,veterinary,etc.)and uses Dn y medical gases. ❑ C. This business operates a farm for purposes of cultivating the soil,raising, or harvesting an \ A agricultural or horticultural commodity. Q3. ❑Yes Cho Does your business handle an Acutely Hazardous Material? See definition on reverse side of this form. Q4. ❑Yes *Io Is your business within 1,000 feet of the outer boundary of a school(grades K-12)? I have read the information on this forth and understand my requirements under Chapter 6.95 of the California Health and Safety Code. I understand that if I own a facility or property that is used by tenants,that it is my responsibility to notify the tenants of the requirements which must be met prior to issuance of a Certificate of Occupancy or beginning of operations. I declare under the penalty of perjury that the information provided on this disclosure survey is true and accurate to the best of my knowledge. Owner or Authorized Agent:nt X I" J'it" / Date �. X tN % Title ✓ t cs? Po 1 Sign (Rev 4/99)