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SAN JOAQUIN Environmental Health Department <br /> ---COUNTY — <br /> NAZAROOUS MATER/ALS �/SGLOSURE SURVEY <br /> A saparele survey fomr Iv requlretl far each business name and/or address In San Joaquin County. <br /> Businaea Nama: Railport Logistics Inc/Ranlit GIII Telephone: <br /> Business Site Atlarasa: 200.150 antl 212 Frawert Road.Lamrop,CA.96330 <br /> Mallln9 Adaresa(n dlHarant Irom above): 403 Riley Court,TYacy.CA.853]7 <br /> Buslnasa Owner(a)Nama: RaNif GIII Telephone: [2097 640-g078 <br /> Buainesa Owner Atltlresa: 403 Riley Court,Treey.CA.95371 <br /> Nalur¢of Business: Truck perking Fire DiaMcb Lathrop FD <br /> Ot, d Y¢s O No Doea your business hantlla a hazardous malarial in a anniv a[any one Uma in Iha year? <br /> Sea the daflnllion of hazertlous meteaal on page 2 of Ihls form. <br /> o Yes t9 NO Doea your business generate,treat,or store a hazardous waste In am ouantitvl(uaatl oil,used <br /> antifreeze.waste so Went.etc.) <br /> If your answer rs"No•'to both qussnone In Ot,please print,sl9n,antl Bats the DeHem e1<hla form and return to tDa aaaresa above. <br /> D2. p Yea o No Dces your bualneba handle a hazardous ma[aaal,or a mlMure containing a hazardou9 material. <br /> in a quanmy equal to or greater man ss genona.sou Iwunas,ar zoo cubic teat et any one oma <br /> In the yean <br /> If'Y93-,how IOng M1eva you handled masa matarlals at your buaMasa? 29 yaara <br /> IF"Yes',shock any O/[he following condl9ona IDs[apply to your Duslnaea: <br /> w A. Tha Hazardous ma[arlals handlatl by This business era contained solely in a conaumar protluct <br /> packegetl Tor tlirect tllsMbmign M antl use by Iha general public. <br /> o B. This business operates a fano for purposes of cultivating the soil, raising or harvesting an <br /> egticullurel or hoHicuiturel commodity. <br /> 03. o Yea p[No DOa3 yOVf bu3lnasa handle an Aculaly Ha28rdOVa Meleriall Saa daflnition on page 2. <br /> 04. o Yea n No Is your business within 1,000 feat of the outer boundary of a achool7(Grease K-12) <br /> 1 have reatl[M1e Information on mis form antl understand my requirements untlar Chapter 6.85 of the California Healm antl Safety <br /> Coda(HSC). 1 understand that i/1 own a faoility or property mat Is used by tenants.tt Is my rasppnelblllry tq notlfy the tenants of the <br /> requirements which must ba mat prior to is soca of a Cartifleate of Occupancy or beginning of operations. 1 declare unser the <br /> penally of perjury thea Ne Inbrmatlon provldrM on mis dladoaure survey Is true and accurate to Iha bast of my knowledge. <br /> If you anawared"Yes"t0 puea[lOn 2,please go online to cera caleoa c a v to submit your hazardous matarlals information. <br /> Owner or Authorized Agent <br /> R t Gill Q Z—a- ` �a'7- <br /> Pant Nama: ty� � � Dale: _�7 p <br /> Bi9nature: "� ��\ _ TNIa: \'J`��fJ�9t�/� <br /> �v...rprJF.Q ArLGIt.�- X �� <br /> �nur' K� n/xlLJ�w� � cs/•�/�� f�Fwr�Df,.� �,*"cam" oal�l2z <br /> ��gjrih i`—r�'M/l CB's-1 ���c� C_C�-'lig <br /> 1868 E.iHaz�lton Avanua I StpcKton.California 95205 I T 209 468-3420 I F 209 4640136 I www.aj¢eha.¢pm <br />