Laserfiche WebLink
i i RECEIVED <br /> .. � COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES Al " 207 <br /> :< A <br /> Room 610, Courthouse JHIVJUHUUINGUUNIY <br /> 3� ry n 222 East Weber Avenue OFFICE OF EMERGENCY SERVICES <br /> Stockton, California 95202 <br /> Telephone(209)468-3962 <br /> Hazardous Materials Division (209)468-3969 <br /> HAZARDOUS MATERIALS DISCLOSURE SURVEY <br /> Please read the information on the reverse side before completing this survey form. A separate survey for each business <br /> name and/or address in San Joaquin County is required. <br /> Business Name: California Lowbed Rentals Limited Partnership <br /> Tom & Delores Pistacchio ele <br /> Business Owner(s) Name:& David AGalloway & f ria Trailer S:les I I(� phone: 209-931-30 93 <br /> Business Address: 4907 Waterloo Road Stockton, CA 95215 <br /> Mailing Address (if different from above): SAME <br /> Nature of Business: Lowbed trailer rental & Leasing Fire District: Morada <br /> Q1. []Yes ININo 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. DYes IXNo Does your business handle a hazardous material, or a mixture containing a hazardous material in a <br /> quantity equal to or greater than 55 gallons, 500 pounds, or 200cubic 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 /> DA. The hazardous materials handled by this business is contained solely in a consumer product, <br /> packaged for direct distribution to, and use by, the general public. <br /> DB. This business is a health care facility(doctor,dentist, veterinary, etc.)and uses only medical gases. <br /> DC. This business operates a farm for purposes of cultivating the soil, raising, or harvesting an <br /> agricultural or horticultural commodity. <br /> Q3. DYes 0ONo Does your business handle an acutely hazardous material? See definition on reverse side of this form. <br /> Q4. OYes I&No Is your business within 1,000 feet of the outer boundary of a school (grades K-12)? <br /> 1 have read the information on this form and understand my requirements under Chapter 6.95 of the California Health and <br /> 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 <br /> tenants of the requirements which must be met prior to issuance of a Certificate of Occupancy or beginning of operations. I <br /> declare under the penalty of perjury that the information provided on this disclosure survey is true and accurate to the best <br /> of my knowledge. <br /> Owner or Authorized Agent: <br /> X Tom G. Pistacchio Date: A <br /> Print N T! <br /> X � � Title: limited Partner <br /> Signature <br /> F1DevSvc\P1anning Application Forms\Business License(Revised 08-30-06) Page 4 of 7 <br />