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FROM TOTE—R—SHED. INC. . . PHONE NO. : 14092944519 Apr. 29 2003 09:21AM P1 RECEIVED APR 2 9 2003 sm "WSEW COUNTY OF SAN JOA•QUIN Ma;;= aP-auI"•.e OFFICE OF EMERGENCY SERVICES RONALD E.BALDwIN ROOM 610,COURTHOLSE DIRECTOR OF 222 EAST WEBER AVENUE EMERGENCY OPERATIONS STOCKTON,CALIFORNIA 95202. rrE6x" TELEPHONE(209)463-3962 . .HAZARDOUS MATERIALS DIVISION( 468-3949, qq 0j0j HAZARDOUS MATBRIALS 'DISCL SURE SURVEY - Please read the information on the reverse side before complefing.this survey form. A separate Survey for each business name 'and/or address in San Joaquin County is required. Business Name: 'TOTE—A—SHEI)i INC. Business Owner(s)Name: Robert Hill Telephone: 800.423.8683 2701 So. HwY 99 Stockton, CA . BOsioess Address: Mailing Address(if different from above): 348 Phelan Ave San. Jose, CA 95112 Nature of Business: storage. containers Fire District: QI. es ONO Does.your business handle a hazardous material in any quantity at anyone time in the year? Seethe definition of hazardous material on the back of this form. If your answer is"Ne',,go to Question 4.: Q2-, CYes I0 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. C B. This business is a health care facility(doctor,dentist,veterinary,etc.)and uses on1Y medical gases. ❑ C. This business operates a farm for Purposes of cultivating the soil,raising,or harvesting an agricultural-or horticultural commodity. 03: L—Yes C o Does your business handle an Acutely Hazardous Material? See definition on reverse side of this form . Q4. CYesto Is your business within 1,00o feet of the outer boundary of a school(grades K-I2)? I have read the information on this form and understand my requirements under Chapter 6.95 of the Califomia 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 Certificateaf Occupancy or beginning of operations. I declare under the penalty of perjury that the information provided on this 'SeInsure survey is true and accurate to the best of my knowledge. Owner or Authorized Agent: I`^ '/`�1"' isign Date X, pf �kTitle �X (Rev 09)