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i ! Dept,: fes„y <br /> SAN J()AOU1N COUNTY Liie —- 92`.Gl!J2� <br /> OFFICE OF EMERGENCY SERVICES <br /> HAZARDOUS NIA,rERIALS DISC IA)SURE SURVEY <br /> ITF.ASE PRINT 0R TYPE <br /> Q1. Please provide a separate survey for each business mime: and address in San loayuiaz <br /> County: <br /> I a. Business Name: MID VALLEY AGRICULTURAL SERVIClj,�jne: 931- 9411 <br /> b. Mailing Address: P.O. BOX 593 <br /> LINDEN,CALIFORNIA 95236 <br /> c. Facility Address: 16401 E.HWY. 26 <br /> LINDEN,CALIFORNIA 95236 <br /> d. Contact Name: LARRY BECK Phornc:931-9411 <br /> e. Nature of l3lttitness: RETAIL AGRICULTURAL FER'T'ILIZER & CHEMICAL SALES <br /> i f. Proposed Project: ruAl GF. CSF T3Sr. PFRmTT <br /> Q2. Will the owner, applicant or future building occupant handle a hazardous material:' <br /> {includes gasoline, oil, propane, oxygen, acetylene, amtnonia, chlorine, pesticides,•. . . ) <br /> _. Yes No <br /> Q3. Will the owner, applicant or future building occupant handle an Acutely Fi:azardouN Material? <br />! (List of Acutely Hazardous Materials available at the Planning Department) <br /> Yes No <br /> Q4. Will the proposed building or modified facility be within 1,(X)O feet of the outer bcntndary of <br /> a school (grades K - 12)? <br /> Yes No <br /> .. <br /> I have read the Hazardous Materials Information Guide (on back pale) and understand tzt}• <br /> requirements under Chapter 6.95 of the California lleallh and Safety Cede Sections 25-505, <br /> 25533, and 25534. I understand that if the building does not currently have a tenant, that it is <br /> my responsibility to notify the occupant of the requirements which must he tact priur to issu. <br /> ance of a Certificate of Occupancy. <br /> Owner or A hori' d Agent: (priaat) LARRY BECK„ <br /> Date: {Signator <br /> (Mce Use Onl' <br /> 1 . San Joaquin Air Pollution Control District <br /> 2321 W. Washington St., Suite I �'_ OCT 7 1992 JI <br /> Stockton, CH 95203 <br /> (2091468-3470 <br /> 7 <br /> 2. San Joaquin County OES <br /> 222 East Weber Auenue, <br /> Boom 610H <br /> Stockton, C#1 95202 <br /> (209)468-39692.0 <br />