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FROM TOTE—A—SHED. INC. PHONE NO. 14082944519 Apr. 30 2003 07:07AM P1 <br /> RECEIVED <br /> APR 3 0 2003 <br /> COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES RONALD E.9ALI;%1 IN <br /> e:' y <br /> ROOM 610,COURTHOUSE DIRarroR OF <br /> 222 EASTWEBER AVENUE EMERGENCY OPERATIONS <br /> *...• F STOCKTON,CALIFORNIA 95202. <br /> rafda�� TELEPHONE(Z09)468-3962 - <br /> HAZARDOUS MATERIALS DIVISION( 68-33969. �O� <br /> HAZARDOUS MATERIALS DISCL SURE SURVEY <br /> Please read the information on the reverse side before completing this survey form. A separate survey for each business name <br /> and/or address in San Joaquin County is required. LA <br /> Business Name: TOTE—A—SHED, INC. NJ lo1, <br /> qz � <br /> Business Owner(s)Name: Robert Hill Telephone: 800.423.8683 <br /> Business Address: 2701 So, Hwy 99 Stockton, CA . <br /> MailingAddress(if different from above): 398 Phelan Ave San, Jose, CA 95112 <br /> Nature of Business: storage. containers Fire District <br /> QI. es CNo Does,your business handle a hazardous material in any quantity at any one time in the year? See the <br /> definition of hazardous material on the back of this form. If your answer is"No"..go to Question 4- <br /> Q2. GYes' two Docs your business handle a hazardous material,or a mixture containing a hazardous material;in a . <br /> \` quantity equal to or greiusr than 55 gallons,500 pounds,or 200 cubic feet at 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 applies to your business?, <br /> C A. The hazardous materials handled by this business is contained solely in a consumer product packaged for <br /> direct distribution to,and use by,the general public. <br /> O B. This business is a health care facility(doctor,dentist,veterinary,etc.)and uses p ly medical gnus. <br /> G C. This business operates a farm for purposes of cultivating the soil,raWn¢,or harvesting an <br /> y,r agricultural or horticultural commodity. <br /> Q3. OYes `L/7o Does your business handle an Acutely Hazardous Material? See definition on reverse side of this form <br /> Q4. CYes /I�tN`o 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. 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 <br /> the requirements which must be met prior to issuance of a Certincate of Occupancy or beginning of operations. I declare under the <br /> penalty of pe6ury that the information provided on this 'sclosure survey is true and accurate to the best of my knowledge. <br /> Owner or Authorized Agent: yy��. <br /> X obc ate <br /> ?( Title <br /> Sign (Rev 4199) . <br />