Laserfiche WebLink
PA2200250 <br /> 4 ti San Joaquin County <br /> DIRECTOR <br /> �' � Environmental Health Department DonnaHamn.REHS <br /> l '' '1868 E Hazelton Avenues PROGRAM COORDINATORS <br /> SYOo1CYOnr California 95205 RaDert MCClellon.REHS <br /> y'. �- Jaff CamaaYco.REHS.RDI <br /> oR`�� Linde TurKaba,REHS <br /> Website: xywwsigov.ol'9/aha? <br /> Phone: (2Og)488-3420 Rotlnay Eatmda.REHS <br /> Fai: (209)488 '433 Adrianne Ellsaassar.REHS <br /> HAZARDOUS MATERIALS DISCLOSURE SURVEY <br /> A sapareta survey Tortn is required for each business name and/or address In Sen Joaquin Counly. <br /> Business Nama: AT&T Mobility Telecom site facility CVL00847 (Unmanned) Telephone: <br /> Business SI[e Address- 99 Frontage Rtl,Manteca,CA 95336 (Delta College district-Manteca C¢nt¢r Farm/Laboratory) <br /> Mailing Address(If tlgfereni from above): 5151 Pacific Avenue Stockton CA 95207 <br /> Business Ownar(s)Nama:New Cingular Wireless PCS LLC dba AT&T Mobility Telephone: <br /> Business Owner Andreas: C/O Eplc Wireless Group 606 Coolidge Dr,suite 700, Folsom CA 96630 <br /> Nature of Bdsinesa: Unmanned Telecom facility(cell tower) Fara Dlstdcr. <br /> C7. o vas �fVo Doea vogr bgatogas handle a nazamoga matarlal m any nuannty at env one nme in the <br /> yeah Sea the definition of hazardous matarlal on pa9a 2 of this forth. <br /> v Yas �r I1Jo Coes your business generate,treat,or store a hazardous waste In any cuantiNT(used oil. <br /> used antifreeze,waste solvent,etc.) <br /> If your answer Is"Nra^<e beth questions In Ot,please prinl,elan,and data tM bottom o(tbla form snd m<um to the addwsa abraya. <br /> Q2. o Vas J/No Coas your business handle a hazertlous matarlal, ora mixture containing a hazardous <br /> matarlal,In a quantity equal to or greater than Es gallons,600 pounds,or 200 cubic feat at <br /> any one time In the yeah <br /> If'Yes".how long have you handled these materiels at your businasaT <br /> If"1'es'",check any of IM1e following conditions that apply to your business: <br /> v A. Tha hazardous materials handled by this Dusinesa a ontainad solely in a consumer <br /> product parka9ad for direct distribution Lo end use by the general public. <br /> o B. This business operates a farm for purposes of cultivadng the soil,raising or harvesting an <br /> agricultural or hor[icul[urel commodity. <br /> C3. o Vas �IJo Coas yqur business handle an Acutely Hazardous Ma[adelT Sea deflnitlon on pa9a 2. <br /> Q4. o Vea �No Is your business within 1,000 feat of the outer bountlary of a achcolT(Grades K-tz) <br /> 1 have read the information on this form and undaretantl my requirements under Chapter 6.95 of Iha Callfomia Health and <br /> Safety Cada(HSC). I understand the[If 1 own a factlily or property that Is used by tenants, it Is my rasponsiDility to no[ITy[M1a <br /> tenants of[ha requirements which mus[ba ma[prior to Issuance of a CertlFlcata of Occupancy or beginning of operations. 1 <br /> declare under the penalty of paqury[hat the information provided on This disclosure survey Is bus and accurate to the bas[of <br /> my knowledge. <br /> Owner or Authorized Agent <br /> Print Nama: Carl Jones(AT&T Agent) Date. ZO/I I/2022 <br /> signature: �e�.>,¢s- nae: AT&T Agent <br /> 7 <br />